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).
To determine the feasibility, safety and efficacy of tight glycaemic control in patients on an AMU.
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.
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.
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.
Hyperglycaemia is associated with poor outcomes from acute chronic obstructive pulmonary disease (COPD) exacerbations requiring hospital admission.
It is not known whether glycaemic control can improve COPD exacerbation outcomes.
The aim of this phase II study was to determine the feasibility, safety and efficacy of tight glycaemic control with insulin in COPD patients with exacerbations on acute medical wards, towards testing this intervention in a randomised controlled trial.
Tight glycaemic control with insulin was feasible and acceptable to patients in a general ward setting.
The efficacy and safety of tight glycaemic control were similar in COPD patients on acute medical wards to that achieved in intensive care settings, with improved glycaemic control but increased hypoglycaemia and glycaemic variability.
Strengths and limitations of this study
This study was conducted when tight glycaemic control was standard practice in intensive care units (ICUs), following the publication of two single-centre studies demonstrating reduced morbidity and mortality compared with conventional glycaemic control.
More recent ICU studies have shown no benefit and possible harm from tight glycaemic control.
In this context, our finding that tight glycaemic control in the acute medical unit has a similar safety and efficacy to ICU protocols indicates that we should explore alternative strategies for blood glucose control in COPD exacerbations.