Comparison of two protocols in the management of glucocorticoid-induced hyperglycemia among hospitalized patients

Abstract

Context:There is limited literature focusing on the management of glucocorticoid-induced hyperglycemia (GCIH).Aims:The primary objective was to compare the mean blood glucose between the experimental group (new protocol) and the control group (standard protocol) in the management of GCIH. The secondary objective was to compare other parameters of glycemic efficacy, variability, and safety parameters.Methods:This was a randomized, open-labeled, parallel arm trial. Adult patients who were given glucocorticoid (minimum dose equivalent to prednisolone 10 mg) in the past 24 h and had 2 h postmeal plasma glucose ≥200 mg/dl were included in the study. Patients randomized to control group received standard basal-bolus insulin. In the experimental group, a “correctional insulin” matching the glycemic profile of the glucocorticoid administered was provided with or without “background” basal-bolus insulin. The parameters of glycemic efficacy, variability, and safety were compared. P < 0.05 was considered statistically significant.Results:Data of 67 patients included in the study were analyzed, of which 33 patients were in the experimental group and 34 patients in the control group. The mean blood glucose in the experimental and the control group was 170.32 ± 33.46 mg/dl and 221.05 ± 49.72, respectively (P = 0.0001). The parameters for glycemic variability were all significantly lower in patients in the experimental group. The hypoglycemia event rate was low in both the groups.Conclusion:When compared to the standard basal-bolus insulin protocol, the new protocol showed lower mean blood glucose and lower glycemic variability.

Steroid-induced hyperglycemia: An underdiagnosed problem or clinical inertia? A narrative review

“…Therefore, glucose monitoring across the first 48 hours is very important in order to identify the most patients developing hyperglycemia, stopping further testing in case of absence of hyperglycemia within the first 48 hours [37]. Table 2 summarizes epidemiological data divided by different conditions according to main recent studies published within 2015 and 2018 [29,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54].…”

“…Lakhani et al, 2017 [42] Randomized, open-labeled, parallel arm trial Any medical condition 67 patients randomized to control group (standard basal-bolus insulin) or the experimental one ("correctional insulin" matching the glycemic profile of the GC with or without background basal-bolus insulin).…”

Evaluación de la eficacia y la seguridad de un protocolo de manejo de pacientes con diabetes descompensada por glucocorticoides durante la hospitalización

“…Existen pocos estudios que hayan analizado diferentes pautas de tratamiento de la DDG en pacientes ingresados en el hospital, y en nuestra revisión de la literatura no hemos hallado ninguno que evaluase prospectivamente los resultados completos durante un horizonte temporal de 2 semanas. El estudio de Lakhani et al recogía los datos a lo largo del ingreso, si bien descartaba todos los valores de glucemia capilar de los días con glucemias < 70 mg/dl o > 400 mg/dl, lo que podría no describir fielmente la realidad del ingreso 14 . En el estudio de Grommesh et al se analizaban los resultados sin tener en cuenta los valores de glucemia capilar del día 1, que es un día en el que los valores de ambos grupos son elevados, debido probablemente a la falta de tiempo para que comience a funcionar el protocolo 17 ; de hecho, en nuestro trabajo, no encontramos diferencias significativas en los valores de GM entre los grupos hasta el cuarto día.…”

Incidence of hyperglycemia in patients with corticosteroid therapy

“…Los GC pueden causar hiperglicemia a través de la resistencia a la insulina, por ende, no es raro observar una tolerancia anormal a la glucosa entre los pacientes que reciben terapia con esteroides. La frecuencia de la hiperglicemia inducida por corticoides es muy variable; en nuestro estudio fue del (15)…”

“…La hiperglucemia inducida por GC ocurre con bastante frecuencia y señala la necesidad del diseño de estudios prospectivos, aleatorizados y controlados para investigar más a fondo y (15,16) comprender mejor este problema médico .…”