Glycemic Control and Variability for Congestive Heart Failure Exacerbation

High glucose as well as fluctuations in blood glucose can contribute to severe hospital
complications and even death. Studies also suggest that heart failure patients who have high
glucose or diabetes do not live as long as patients with normal glucose. Glucose
fluctuations have not been well-studied in patients with heart failure. In this study, we
will determine whether better control of blood sugar fluctuations in the hospital improve
outcomes. We will enroll 80 patients with severe heart failure and divide them into 2
groups. We will use intravenous (given through the vein) insulin to lower blood sugar
levels in group 1, and insulin injections (under the skin) in group 2. We will determine
whether intravenous insulin improves blood markers of inflammation, changes in vital signs,
and other tests that predict mortality in patients with heart failure.

Inclusion Criteria:

- Age 18 and above

- Admitted (less than 48 hours) to the OSU Ross Heart Hospital with worsening heart
failure

- Hyperglycemia or diabetes. Hyperglycemia is defined as blood glucose greater than
150 mg/dL on at least 2 occasions separated by at least 4 hours apart, insulin use,
or HbA1c >6.5%.

Exclusion Criteria:

- Type 1 diabetes

- Receiving comfort care measures only

- Hospital stay expected to be less than 2 days

- Pregnancy

- Prisoners

- Participation in the study on prior hospitalizations

- Acute myocardial infarction within 3 months

- End stage renal or liver disease