Divided dosing reduces prednisolone-induced hyperglycaemia and glycaemic variability: a randomized trial after kidney transplantation

Yates, Christopher J; Fourlanos, Spiros; Colman, Peter G; Cohney, Solomon

doi:10.1093/ndt/gft377

Cited by 39 publications

(24 citation statements)

References 39 publications

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“…One potential approach to treat this pattern of hyperglycaemia is to use insulin isophane as the basal insulin in patients taking prednisolone, which has been recommended as its pharmacodynamic properties match the pattern of hyperglycaemia induced by prednisolone . Alternative options include prescribing higher doses of short‐acting insulin with lunch and dinner or dividing the daily prednisolone dose, which attenuates prednisolone‐induced hyperglycaemia . For once‐daily prednisolone dosing, our data demonstrate that greater delivery of insulin during the afternoon and evening is needed in patients with hyperglycaemia.…”

Section: Discussionmentioning

confidence: 94%

Efficacy of a basal bolus insulin protocol to treat prednisolone‐induced hyperglycaemia in hospitalised patients

Burt

Drake

Aguilar-Loza

et al. 2015

Internal Medicine Journal

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Section: Discussionmentioning

confidence: 94%

Efficacy of a basal bolus insulin protocol to treat prednisolone‐induced hyperglycaemia in hospitalised patients

Burt

Drake

Aguilar-Loza

et al. 2015

Internal Medicine Journal

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“…The impact of steroid avoidance/withdrawal is all the more uncertain given the current use of lower CNI target levels and rapid weaning of corticosteroids. Split corticosteroid dosing may also reduce glycemic variability and peak hyperglycemia (43). …”

Section: Recommendation 5: Choose and Use Immunosuppression Regimens mentioning

confidence: 99%

Proceedings From an International Consensus Meeting on Posttransplantation Diabetes Mellitus: Recommendations and Future Directions

Sharif

Hecking

Vries

et al. 2014

American Journal of Transplantation

421

471

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A consensus meeting was held in Vienna on September 8–9, 2013, to discuss diagnostic and therapeutic challenges surrounding development of diabetes mellitus after transplantation. The International Expert Panel comprised 24 transplant nephrologists, surgeons, diabetologists and clinical scientists, which met with the aim to review previous guidelines in light of emerging clinical data and research. Recommendations from the consensus discussions are provided in this article. Although the meeting was kidney-centric, reflecting the expertise present, these recommendations are likely to be relevant to other solid organ transplant recipients. Our recommendations include: terminology revision from new-onset diabetes after transplantation to posttransplantation diabetes mellitus (PTDM), exclusion of transient posttransplant hyperglycemia from PTDM diagnosis, expansion of screening strategies (incorporating postprandial glucose and HbA1c) and opinion-based guidance regarding pharmacological therapy in light of recent clinical evidence. Future research in the field was discussed with the aim of establishing collaborative working groups to address unresolved questions. These recommendations are opinion-based and intended to serve as a template for planned guidelines update, based on systematic and graded literature review, on the diagnosis and management of PTDM.

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“…Some studies have shown that the ratios of GA to HbA1c (GA:HbA1c) reflect postprandial glucose excursion 13–15. Considering that steroid administration can cause remarkable postprandial hyperglycaemia,16 GA appears to be a good marker for the estimation of blood glycaemic levels in patients with steroid-induced DM. However, GA is not a good marker for glycaemic control in patients with steroid-induced DM.…”

Section: Discussionmentioning

confidence: 99%

A discrepancy between plasma glycated albumin and HbA1c levels in a patient with steroid-induced diabetes mellitus

et al. 2016

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A 57-year-old man was admitted for the treatment of steroid-induced diabetes mellitus (DM). He also had interstitial pneumonia and, to treat it, 20 mg prednisolone had been started in April 2014. Although glycated haemoglobin (HbA1c) level was 7.8% (62 mmol/mol), his glycated albumin (GA) level was normal (13.9%) and the ratio of GA to HbA1c (GA:HbA1c) was lower than that of normal participants and patients with type 2 DM. Plasma GA and GA:HbA1c levels became persistently lower. In September 2015, HbA1c levels measured by HPLC and immunoprecipitation methods were almost the same (6.8% (51 mmol/mol) and 6.7% (50 mmol/mol), respectively), but GA (10.2%) and GA:HbA1c (1.6) were much lower. We report the case of a patient with DM where steroid administration may have caused a decrease in plasma GA and GA:HbA1c levels via increased albumin turnover.

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Divided dosing reduces prednisolone-induced hyperglycaemia and glycaemic variability: a randomized trial after kidney transplantation

Abstract: Split prednisolone dosing reduces glycaemic variability and hyperglycaemia early post-kidney transplant.

Cited by 39 publications

References 39 publications

Efficacy of a basal bolus insulin protocol to treat prednisolone‐induced hyperglycaemia in hospitalised patients

Efficacy of a basal bolus insulin protocol to treat prednisolone‐induced hyperglycaemia in hospitalised patients

Proceedings From an International Consensus Meeting on Posttransplantation Diabetes Mellitus: Recommendations and Future Directions

A discrepancy between plasma glycated albumin and HbA1c levels in a patient with steroid-induced diabetes mellitus

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