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Phase II study of tight glycaemic control in COPD patients with exacerbations admitted to the acute medical unit

BACKGROUND: Hyperglycaemia is associated with poor outcomes from exacerbations of chronic obstructive pulmonary disease (COPD). Glycaemic control could improve outcomes by reducing infection, inflammation and myopathy. Most patients with COPD are managed on the acute medical unit (AMU) outside inten...

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Autores principales: Archer, John R H, Misra, Shivani, Simmgen, Marcus, Jones, Paul W, Baker, Emma H
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Group 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191583/
https://www.ncbi.nlm.nih.gov/pubmed/22021788
http://dx.doi.org/10.1136/bmjopen-2011-000210
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author Archer, John R H
Misra, Shivani
Simmgen, Marcus
Jones, Paul W
Baker, Emma H
author_facet Archer, John R H
Misra, Shivani
Simmgen, Marcus
Jones, Paul W
Baker, Emma H
author_sort Archer, John R H
collection PubMed
description BACKGROUND: Hyperglycaemia is associated with poor outcomes from exacerbations of chronic obstructive pulmonary disease (COPD). Glycaemic control could improve outcomes by reducing infection, inflammation and myopathy. Most patients with COPD are managed on the acute medical unit (AMU) outside intensive care (ICU). OBJECTIVE: To determine the feasibility, safety and efficacy of tight glycaemic control in patients on an AMU. DESIGN: Prospective, non-randomised, phase II, single-arm study of tight glycaemic control in COPD patients with acute exacerbations and hyperglycaemia admitted to the AMU. Participants received intravenous, then subcutaneous, insulin to control blood glucose to 4.4–6.5 mmol/l. Tight glycaemic control was evaluated: feasibility, protocol adherence; acceptability, patient questionnaire; safety, frequency of hypoglycaemia (capillary blood glucose (CBG) <2.2 mmol/l and 2.2–3.3 mmol/l); efficacy, median CBG, fasting CBG, proportion of measurements/time in target range, glycaemic variability. Results were compared with 25 published ICU studies. RESULTS: 20 patients (10 females, age 71±9 years; forced expiratory volume in 1 s: 41±16% predicted) were recruited. Tight glycaemic control was feasible (78% CBG measurements and 89% of insulin-dose adjustments were adherent to protocol) and acceptable to patients. 0.2% CBG measurements were <2.2 mmol/l and 4.1% measurements 2.2–3.3 mmol/l. The study CBG and proportion of measurements/time in target range were similar to that of ICU studies, whereas the fasting CBG was lower, and the glycaemic variability was greater. CONCLUSIONS: Tight glycaemic control is feasible and has similar safety and efficacy on AMU to ICU. However, as more recent ICU studies have shown no benefit and possible harm from tight glycaemic control, alternative strategies for blood glucose control in COPD exacerbations should now be explored. TRIAL REGISTRATION NUMBER: ISRCTN: 42412334. http://Clinical.Trials.gov NCT00764556.
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spelling pubmed-31915832011-10-13 Phase II study of tight glycaemic control in COPD patients with exacerbations admitted to the acute medical unit Archer, John R H Misra, Shivani Simmgen, Marcus Jones, Paul W Baker, Emma H BMJ Open Respiratory Medicine BACKGROUND: Hyperglycaemia is associated with poor outcomes from exacerbations of chronic obstructive pulmonary disease (COPD). Glycaemic control could improve outcomes by reducing infection, inflammation and myopathy. Most patients with COPD are managed on the acute medical unit (AMU) outside intensive care (ICU). OBJECTIVE: To determine the feasibility, safety and efficacy of tight glycaemic control in patients on an AMU. DESIGN: Prospective, non-randomised, phase II, single-arm study of tight glycaemic control in COPD patients with acute exacerbations and hyperglycaemia admitted to the AMU. Participants received intravenous, then subcutaneous, insulin to control blood glucose to 4.4–6.5 mmol/l. Tight glycaemic control was evaluated: feasibility, protocol adherence; acceptability, patient questionnaire; safety, frequency of hypoglycaemia (capillary blood glucose (CBG) <2.2 mmol/l and 2.2–3.3 mmol/l); efficacy, median CBG, fasting CBG, proportion of measurements/time in target range, glycaemic variability. Results were compared with 25 published ICU studies. RESULTS: 20 patients (10 females, age 71±9 years; forced expiratory volume in 1 s: 41±16% predicted) were recruited. Tight glycaemic control was feasible (78% CBG measurements and 89% of insulin-dose adjustments were adherent to protocol) and acceptable to patients. 0.2% CBG measurements were <2.2 mmol/l and 4.1% measurements 2.2–3.3 mmol/l. The study CBG and proportion of measurements/time in target range were similar to that of ICU studies, whereas the fasting CBG was lower, and the glycaemic variability was greater. CONCLUSIONS: Tight glycaemic control is feasible and has similar safety and efficacy on AMU to ICU. However, as more recent ICU studies have shown no benefit and possible harm from tight glycaemic control, alternative strategies for blood glucose control in COPD exacerbations should now be explored. TRIAL REGISTRATION NUMBER: ISRCTN: 42412334. http://Clinical.Trials.gov NCT00764556. BMJ Group 2011-07-23 /pmc/articles/PMC3191583/ /pubmed/22021788 http://dx.doi.org/10.1136/bmjopen-2011-000210 Text en © 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
spellingShingle Respiratory Medicine
Archer, John R H
Misra, Shivani
Simmgen, Marcus
Jones, Paul W
Baker, Emma H
Phase II study of tight glycaemic control in COPD patients with exacerbations admitted to the acute medical unit
title Phase II study of tight glycaemic control in COPD patients with exacerbations admitted to the acute medical unit
title_full Phase II study of tight glycaemic control in COPD patients with exacerbations admitted to the acute medical unit
title_fullStr Phase II study of tight glycaemic control in COPD patients with exacerbations admitted to the acute medical unit
title_full_unstemmed Phase II study of tight glycaemic control in COPD patients with exacerbations admitted to the acute medical unit
title_short Phase II study of tight glycaemic control in COPD patients with exacerbations admitted to the acute medical unit
title_sort phase ii study of tight glycaemic control in copd patients with exacerbations admitted to the acute medical unit
topic Respiratory Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191583/
https://www.ncbi.nlm.nih.gov/pubmed/22021788
http://dx.doi.org/10.1136/bmjopen-2011-000210
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