Phase II Study of Safety and Feasibility of Intensive Blood Glucose Control With Insulin on Acute Medical Wards

Phase II Study of Safety and Feasibility of Intensive Blood Glucose Control With Insulin on Acute Medical Wards

Patients with chronic obstructive pulmonary disease (COPD) are commonly admitted to hospital with exacerbations of their lung disease. A combination of the acute illness and treatment with oral steroids causes a rise in blood sugar. Patients with high blood sugar do worse than those with normal blood sugar. The aim of this study is to develop a safe and effective protocol for tight control of blood glucose with insulin on acute medical wards outside the intensive care environment. This will allow us to perform a formal trial to determine whether blood glucose control with insulin reduces death and complications from COPD exacerbations.

Inclusion Criteria:

• Physician diagnosis of AECOPD as primary cause for admission
• Able to enter study within 24 hours of admission

Exclusion Criteria:

• Intensive care unit admission
• Moribund or not for active treatment
• Admission expected to last <48 hours
• Unable or unwilling to give informed consent
• Known Type I diabetes mellitus
• Patients with reduced awareness of hypoglycaemia including reduced Glasgow coma scale or those taking beta blockers
• Patients with renal or hepatic failure at increased risk of hypoglycaemia