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Diabetology
Volume 7
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10.3390/diabetology7050094
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

A Pragmatic Cluster-Randomized Trial of Insulin Therapy for Dexamethasone-Induced Hyperglycemia Amongst Diabetes Patients with COVID-19

by
Ngai Wah Cheung
1,2,3,*,
Amanda Hor
1,
Simone Marschner
3,
Christopher Chan
1,
Haeri Min
3,
Lauren Lee
1,
Tien-Ming Hng
4,5,
Yoon Ji Jina Rhou
1,2,
Yu-Fang Wu
1,
Mawson Wang
1 and
David R. Chipps
1,2
1
Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW 2145, Australia
2
Faculty of Medicine and Health, The University of Sydney, Parramatta Road, Camperdown, NSW 2006, Australia
3
Westmead Applied Research Centre, The University of Sydney, Westmead Hospital, Westmead, NSW 2145, Australia
4
Department of Diabetes and Endocrinology, Blacktown Mt Druitt Hospital, Blacktown, NSW 2148, Australia
5
School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
*
Author to whom correspondence should be addressed.
Diabetology 2026, 7(5), 94; https://doi.org/10.3390/diabetology7050094 (registering DOI)
Submission received: 23 March 2026 / Revised: 29 April 2026 / Accepted: 6 May 2026 / Published: 9 May 2026
(This article belongs to the Special Issue Advances in Inpatient Diabetes Care)
Versions Notes

Abstract

Background: Glucocorticoid-induced hyperglycemia is common amongst hospitalized patients. Isophane insulin has been proposed as part of the optimal insulin regimen for managing this, but there are few randomized controlled trials to support this. Our aim was to determine if the addition of a morning dose of isophane insulin would improve glycemic control amongst patients with COVID-19 who had dexamethasone-induced hyperglycemia (DIH) in hospital. Methods: Patients with diabetes admitted to hospital with COVID-19 respiratory infection and treated with dexamethasone were cluster-randomized by ward to receive either basal bolus insulin (BBI) or isophane-augmented BBI (IaBBI) in equipotent doses. Insulin commencement and titration were guided by standardized protocols. The primary outcome was overall finger-prick blood glucose (BG) levels, with predefined secondary outcomes of BGs on day 3 and the final day of admission. Results: A total of 40 patients were included, 25 in the IaBBI group and 15 in the BBI only group, for a duration of 5.4 ± 2.2 days. Both recruitment and the trial were terminated early because of a rapid decline in COVID-19 admissions. There were no differences in overall mean BG levels (IaBBI 11.9 ± 2.5 mmol/L vs. BBI 12.6 ± 2.4 mmol/L, p = 0.193) between the groups. Mean day 3 BGs were lower in the IaBBI group than in the BBI group (11.1 ± 3.5 mmol/L vs. 12.7 ± 3.5 mmol/L, p = 0.029) and on the final day (9.6 ± 2.8 mmol/L vs. 10.7 ± 2.5 mmol/L, respectively, p = 0.011). Conclusions: The restricted sample size in this study limits any conclusions that can be made regarding the effectiveness of the addition of isophane insulin to a BBI insulin regimen for diabetes patients with COVID-19 infection and DIH. However, some improvements in glycemic control were observed, suggesting that this is a glucose management strategy that warrants further evaluation.
Keywords: COVID-19; dexamethasone; hyperglycemia; insulin; randomized controlled trial COVID-19; dexamethasone; hyperglycemia; insulin; randomized controlled trial

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MDPI and ACS Style

Cheung, N.W.; Hor, A.; Marschner, S.; Chan, C.; Min, H.; Lee, L.; Hng, T.-M.; Rhou, Y.J.J.; Wu, Y.-F.; Wang, M.; et al. A Pragmatic Cluster-Randomized Trial of Insulin Therapy for Dexamethasone-Induced Hyperglycemia Amongst Diabetes Patients with COVID-19. Diabetology 2026, 7, 94. https://doi.org/10.3390/diabetology7050094

AMA Style

Cheung NW, Hor A, Marschner S, Chan C, Min H, Lee L, Hng T-M, Rhou YJJ, Wu Y-F, Wang M, et al. A Pragmatic Cluster-Randomized Trial of Insulin Therapy for Dexamethasone-Induced Hyperglycemia Amongst Diabetes Patients with COVID-19. Diabetology. 2026; 7(5):94. https://doi.org/10.3390/diabetology7050094

Chicago/Turabian Style

Cheung, Ngai Wah, Amanda Hor, Simone Marschner, Christopher Chan, Haeri Min, Lauren Lee, Tien-Ming Hng, Yoon Ji Jina Rhou, Yu-Fang Wu, Mawson Wang, and et al. 2026. "A Pragmatic Cluster-Randomized Trial of Insulin Therapy for Dexamethasone-Induced Hyperglycemia Amongst Diabetes Patients with COVID-19" Diabetology 7, no. 5: 94. https://doi.org/10.3390/diabetology7050094

APA Style

Cheung, N. W., Hor, A., Marschner, S., Chan, C., Min, H., Lee, L., Hng, T.-M., Rhou, Y. J. J., Wu, Y.-F., Wang, M., & Chipps, D. R. (2026). A Pragmatic Cluster-Randomized Trial of Insulin Therapy for Dexamethasone-Induced Hyperglycemia Amongst Diabetes Patients with COVID-19. Diabetology, 7(5), 94. https://doi.org/10.3390/diabetology7050094

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