Group A (n = 11)
Group B (n = 13)
Group C (n = 64)
Women/men
6/5
7/6
38/26
Age (year)
61.4 ± 11.0
53.7 ± 12.5
48.3 ± 14.4**
BMI (kg/m2)
30.6 ± 4.2
31.1 ± 7.2
29.6 ± 6.9
Atopy (n)
6
6
36
Asthma duration (year)
17.7 ± 8.9
17.1 ± 9.2
13.7 ± 7.5
Daily dose of prednisolone (mg)
6.25 ± 7.72
7.69 ± 9.04
5.88 ± 6.11
Daily dose of budesonide (mg)
0.68 ± 0.57
0.65 ± 0.51
0.62 ± 0.44
Patients with diabetes (n)
4
5
0
Diabetes duration (year)
5.5 ± 3.4
2.8 ± 1.3
0
FEV1 (%pred.)
45.6 ± 12.9 (26–50)
42.5 ± 14.9 (16–48)
41.8 ± 7.2 (24–49)
PcO2 (mmHg)
62.2 ± 5.8 (55–69)
61.2 ± 6.2 (51–70)
63.1 ± 6.0 (52–70)
Glycemia (mmol/l)
10.2 ± 1.8 (8.6–13.4)
10.9 ± 3.0 (8.5–18.1)
5.6 ± 0.9 (4.9–8.2)***
HbA1c (%)
6.1 ± 0.6 (5.3–7.0)
6.9 ± 2.1 (3.5–9.1)
–
The following tests were conducted on all patients on the first day of study: complete blood count, chemistry tests, concentration of glycated hemoglobin (HbA1c), C-reactive protein, general urine test, ECG, chest X-ray, and pulmonary function tests. If an infection of the respiratory tract was suspected, sputum was taken to grow culture.
The blood glucose level was measured every hour over the initial 4 h of treatment. Further measurements were conducted eight times a day: before breakfast (8:00 a.m.), 11:00 a.m., before lunch (1:00 p.m.), 3:00 p.m., before dinner (6:00 p.m.), 8:00 p.m., before night meal (10:00 p.m.), at night (3:00 a.m.). Blood glucose was measured with an Accu-Check glucometer (Roche Diagnostics, Basel, Switzerland) the result was a mean of two repeat measurements. The diet of patients was established at 25 kcal/kg/day, 30 % of which was fats, 40 % carbohydrates, and 30 % protein.
Every morning, each patient was subjected to pulmonary function tests. PEF was measured before nebulizations at 08:00 a.m. and 8:00 p.m., and gasometry of arterialized blood was performed.
If after the first day of treatment there was no need to supply additional doses of MP or nebulization, PEF or FEV1 were >59 %, and PcO2 > 70 mmHg, the daily dose of MP was halved and nebulized budesonide was added in a dose of 1 mg μg b.i.d (Pulmicort, AstraZeneca; London, UK). Nebulized salbutamol and ipratropium bromide continued at initial doses. Thereafter, it was established at daily intervals whether the patient meets the above outlined criteria of MP dose reduction and inclusion of nebulized budesonide. After MP reduction and addition of budesonide, MP dose was further halved when PEF or FEV1 increase was greater than 10 % compared with the previous day or reached 80 % of predicted value. The i.v. dose of MP was continually reduced in like manner down to 40 mg/day, after which it was replaced with oral prednisone – 20 mg/day. Then, the patient was discharged the day following that when FEF or FEV1 remained stable or decreased no more than 10 %. In both groups, in patients with prediagnosed diabetes insulin treatment continued uninterrupted. In patients without the diagnosis of diabetes before inclusion into the study the treatment with insulin was withheld when the required daily dose fell below 12 units and three successive measurements of blood glucose were below 5.8 mmol/l.
2.2 Statistical Analysis
The main outcome variable analyzed in the study was the duration of hospitalization of patients with acute asthma exacerbation and hyperglycemia treated with intravenous insulin (Group A) or subcutaneous insulin (Group B) as compared with patients having no disturbance in the blood glucose level (Group C). A single-factor analysis was made using the Kaplan-Meier curves where a chi-squared test or Gehan-Wilcoxon test was applied for comparisons. A multi-factor analysis (combined influence of the kind of treatment, sex, age, and FEV1) was made using the Cox proportional hazard model where the significance of individual factors was studied with the Wald test. Data were presented as means ± SD or medians. P < 0.05 defined the statistical significance of differences.
3 Results
The course of treatment is shown in Table 2. The patients’ clinical condition in both groups improved during treatment compared with the initial condition, which was manifested by increases in FEV1 and PcO2. The average daily doses of MP and insulin did not differ in Group A and B. However, the daily dose of MP in Group C was significantly lower than that in Group A or B (p < 0.05). Two patients in Group A and 4 patients in Group B required an antibiotic due to respiratory infection. The goal to keep the blood glucose level under the set outpoint was achieved in Group B, where it was, on average, below 11.1 mmol/l, but not in Group A, where it was higher by 0.6 mmol/l than the upper limit of 7.2 mmol/l. Additionally, there were three incidents of hypoglycemia in Group A.
Table 2
The course of treatment in both groups
Group A | Group B | Group C | |
|---|---|---|---|
FEV1 (%pred.) | 60.6 ± 19.5 | 58.5 ± 25.9 | 62.2 ± 23.2 |
Morning PEF (%pred.) | 47.9 ± 12.2 | 45.2 ± 11.7 | 52.7 ± 16.1 |
Evening PEF (%pred.) | 47.3 ± 12.6 < div class='tao-gold-member'>
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