Insulin Therapy in Chronic Obstructive Pulmonary Disease (COPD) Exacerbations
Insulin Therapy in Chronic Obstructive Pulmonary Disease (COPD) Exacerbations
The purpose of this study is to determine the effect of preventing hyperglycaemia in patients
 admitted to hospital with acute exacerbations of chronic pulmonary disease.
Hyperglycaemia is associated with increased morbidity and mortality in patients admitted to
 hospital with acute critical illness, myocardial infarction and stroke. Moreover patients
 with hyperglycaemia have a significantly longer hospital stay, higher rates of ICU admission,
 increased in-hospital mortality and are more likely to require transfer to a nursing home.
 Recently, interventional studies have linked reversal of hyperglycaemia to better clinical
 outcomes especially in acute myocardial infarction, cardiac surgery and in critically ill
 patients.

 In England and Wales, it is estimated that the number of people with COPD is approaching 1.5
 million. The morbidity and economic costs associated with the condition are extremely high
 with approximately 10% of all acute medical admissions caused by exacerbations of the
 underlying condition. As a corollary about 15% of patients with COPD need admission to
 hospital each year.

 Acute hyperglycaemia is common among patients admitted with acute exacerbations of COPD. The
 reasons for this are likely to be multi-factorial including an association between COPD and
 increased risk of developing diabetes at least in women, the elderly nature of the two
 populations and the use of glucocorticoids which markedly increases the risk of
 hyperglycaemia. Admission hyperglycaemia (>11 mmol/l) also appears to predict increased
 morbidity for patients with COPD admitted to intensive care.

 The trial will be a randomised trial of comparison of usual treatment vs intensive insulin
 treatment for patients with COPD who may or may not have diabetes. Patients will take part in
 the trial for the first 5 days during their hospital stay.
Inclusion criteria

 -  Patients who are NOT diabetic, admitted with COPD who are likely to be prescribed
 corticosteroids as part of usual care with an admission glucose level (before
 steroids) between 6.1 and 11.1 mmol/l.

 Exclusion criteria:

 -  Patients with diabetes mellitus

 -  Patients who are nil by mouth.

 -  Patients with severe co-morbid disease with an anticipated life expectancy of < 6
 months.

 -  Patients who are unable to provide informed consent.

 -  Age <18 years.