Background: Steroid (glucocorticoid) -induced hyperglycemia is common in hospitalized patients treated with prednisolone and often requires prandial insulin. Evidence is limited regarding whether rapid-acting insulin analogs provide different glycemic profiles compared with regular human insulin under protocol-based titration. Methods: We conducted a single-center, non-randomized, open-label, crossover study in hospitalized adults with type 2 diabetes or steroid-induced diabetes who were receiving morning oral prednisolone (≥5 mg/day) and required insulin therapy. After an insulin dose-adjustment period (with non-insulin agents withheld throughout the dose-adjustment and study periods), participants received insulin glulisine and regular human insulin on consecutive study days without a washout interval, switching unit-for-unit at identical pre-meal doses. Glucose profiles were assessed using continuous glucose monitoring (CGM). Primary endpoints were total glucose area under the curve (AUC) over 0-24 hours and time-segment AUCs (0-8, 8-12, 12-18, and 18-24 hours). Results: Thirteen of 26 eligible patients provided informed consent; six were excluded because >25% of expected CGM readings were missing, all due to device-related recording issues, leaving seven patients for analysis. The total AUC did not differ between insulin glulisine and regular human insulin (118. 02 ± 30. 95 vs 117. 41 ± 30. 20 ×10² mmol/L·min; P = 0. 925), and no significant differences were observed in time-segment AUCs. Mean glucose, maximum glucose, minimum glucose, mean amplitude of glycemic excursions, and time-in-range metrics were similar. Coefficient of variation was lower with insulin glulisine (28. 81 ± 9. 05% vs 34. 55 ± 8. 96%; P = 0. 034). In an exploratory post hoc analysis within a 30-minute time window around 16: 00, AUC, mean glucose, and maximum glucose were lower with regular human insulin than with insulin glulisine (P < 0. 05). Conclusions: Under protocol-based titration during prednisolone treatment, insulin glulisine and regular human insulin produced comparable overall 24-hour glucose exposure. Findings on glycemic variability and post hoc time window analyses should be interpreted as exploratory and warrant confirmation in larger studies.
Takizawa et al. (Wed,) studied this question.