Evaluation of the Impact of Corticosteroid Dose on the Incidence of Hyperglycemia in Hospitalized Patients with an Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Baker, James M.; Pace, Heather A.; Ladesich, James B.; Simon, Stephen D.

doi:10.1310/hpj5104-296

Cited by 15 publications

(11 citation statements)

References 18 publications

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“… 16 , 28 However, whether corticosteroid therapy is associated with hyperglycemia in patients with DM during AECOPD remains controversial. Although studies have indicated that corticosteroid therapy increases the risk of hyperglycemia in all individuals with an underlying respiratory disease, 29 , 30 other studies have argued that corticosteroid treatment does not have a significant effect on the HbA1c levels in patients with DM and AECOPD. 31 , 32 As expected, we also found that patients in the high-risk COPD group had a higher rate of developing ARF and were more likely to use corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

Glycated hemoglobin A1c-based adjusted glycemic variables in patients with diabetes presenting with acute exacerbation of chronic obstructive pulmonary disease

Yang

Tang²,

Wang

et al. 2017

COPD

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Acute hyperglycemia is a common finding in patients presenting to emergency departments (EDs) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Several studies have argued against the association between hyperglycemia at admission and adverse outcomes in patients with diabetes and an acute illness. Recent studies have shown that glucose-related variables (eg, glycemic gaps and stress hyperglycemia ratios) that are adjusted for glycated hemoglobin levels can indicate the severity of a variety of diseases. The objective of this study was to assess whether these hemoglobin A1c (HbA1c)-based adjusted average glycemic variables were associated with unfavorable outcomes in patients admitted to a hospital with AECOPD. We found that 1) pulmonary infection is a major risk factor for AECOPD; 2) a higher glycemic gap and modified stress hyperglycemia ratio were associated with the development of acute respiratory failure (ARF) in patients with diabetes admitted to an ED because of AECOPD; and 3) the glycemic gap and modified stress hyperglycemia ratio had superior discriminative power over acute hyperglycemia and HbA1c for predicting the development of ARF, although the HbA1c-adjusted glycemic variables alone were not independent risk factors for ARF.

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Section: Discussionmentioning

confidence: 99%

Glycated hemoglobin A1c-based adjusted glycemic variables in patients with diabetes presenting with acute exacerbation of chronic obstructive pulmonary disease

Yang

Tang²,

Wang

et al. 2017

COPD

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“…5,8,16,17 This potential difference may be due to the way we determined an increase in blood glucose, which differed compared with other studies. 5,16 The use of a 30% increase from each patient's baseline allowed patients to act as their own reference point, and assess impact of the corticosteroids instead of overall control of diabetes. 8 This potentially provided a more even comparison while including both patients with and without diabetes.…”

Section: Discussionmentioning

confidence: 77%

Evaluation of Corticosteroid Dose in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Hemenway

Terry

2017

Hosp Pharm

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Several recent studies have shown that both lower doses and shorter durations of systemic corticosteroids have similar efficacy for treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, each trial has limitations that constrain direct applicability to a US hospital population. The aim of this study was to determine whether, in a US community hospital, low doses of corticosteroids provide the lowest risk of adverse effects without increasing length of stay or readmission rate. A single-center retrospective cohort was performed using patients meeting criteria for AECOPD. Primary endpoints included length of hospitalization, proportion of patients with >30% increase in blood glucose from baseline, and rate of 30-day readmission; multivariable regression analysis was used for comparison. The 3 inpatient cumulative dose range groups were low: ≤250-mg prednisone equivalents, medium: 251 to 500 mg, and high: ≥501 mg. A total of 665 records were evaluated, with 369 records included. As the corticosteroid dose ranges increased, there were more patients with increased blood glucose (33.3%, 54.4%, 59.9%). When holding all other factors constant, there was a statistically significant increase in patients with elevated blood glucose with the medium- and high-dose groups as compared with the low-dose group ( < .009, < .001), the average length of stay was 21.3 hours higher in the high-dose group as compared with the low-dose group ( < .001), and there were no significant differences in readmission rates between the dose groups. The lowest dose range of corticosteroids was associated with the lowest rate of impaired blood glucose without a statistically significant increase in length of stay or readmission rate.

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“…Corticosteroids reduce inflammation, decrease the risk of treatment failure and promote recovery from symptoms [ 9 ]. However, potential side effects are associated with corticosteroid treatment, including increased risk of infections, osteoporosis, adrenal insufficiency, venous thromboembolisms and hyperglycaemia [ 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Therefore, minimising the accumulated dose of corticosteroids while effectively treating exacerbations is very important.…”

Section: Decreasing Exposure To Corticosteroid Treatmentmentioning

confidence: 99%

Using Blood Eosinophil Count as a Biomarker to Guide Corticosteroid Treatment for Chronic Obstructive Pulmonary Disease

Sivapalan

Bikov

2021

Diagnostics

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Treating patients hospitalised with acute exacerbations of chronic obstructive pulmonary disease (COPD) usually involves administering systemic corticosteroids. The many unwanted side effects associated with this treatment have led to increased interest in minimising the accumulated corticosteroid dose necessary to treat exacerbations. Studies have shown that short-term treatment with corticosteroids is preferred, and recent trials have shown that biomarkers can be used to further reduce exposure to corticosteroids. Interestingly, high eosinophil counts in patients with acute exacerbations of COPD are indicative of an eosinophilic phenotype with a distinct response to treatment with corticosteroids. In addition, post-hoc analysis of randomised control trials have shown that higher blood eosinophil counts at the start of the study predict a greater response to inhaled corticosteroids in stable COPD. In this review, we examine the studies on this topic, describe how blood eosinophil cell count may be used as a biomarker to guide treatment with corticosteroids, and identify some relevant challenges.

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Evaluation of the Impact of Corticosteroid Dose on the Incidence of Hyperglycemia in Hospitalized Patients with an Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Abstract: Study results suggest that a link between larger corticosteroid doses and hyperglycemia incidence may exist, but it requires further study. RESULTS in non-insulin-dependent diabetics provide evidence for increased glucose monitoring upon initiation of corticosteroid therapy.

Cited by 15 publications

References 18 publications

Glycated hemoglobin A1c-based adjusted glycemic variables in patients with diabetes presenting with acute exacerbation of chronic obstructive pulmonary disease

Glycated hemoglobin A1c-based adjusted glycemic variables in patients with diabetes presenting with acute exacerbation of chronic obstructive pulmonary disease

Evaluation of Corticosteroid Dose in Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Using Blood Eosinophil Count as a Biomarker to Guide Corticosteroid Treatment for Chronic Obstructive Pulmonary Disease

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