Treatment of prednisolone‐induced hyperglycaemia in hospitalized patients: Insights from a randomized, controlled study

Abstract

There were no differences in the efficacy or safety of the isophane and glargine-based insulin regimens. We recommend an initial daily insulin dose of 0.5 units/kg bodyweight if not on insulin, a greater than 30% increase in pre-prednisolone insulin dose and larger insulin dose adjustments in patients with prednisolone-induced hyperglycaemia.

MANAGEMENT OF ENDOCRINE DISEASE: Critical review of the evidence underlying management of glucocorticoid-induced hyperglycaemia

“…Ruiz de Adana et al reported that in patients with type 2 diabetes and respiratory disease treated with methylprednisolone or deflazacort, there was no significant difference in glucose control between patients randomized to glargine-or isophane-based basal bolus insulin (39). Similarly, we reported no difference in mean glucose or hypoglycaemia in patients with hyperglycaemia with or without known diabetes while taking short-term prednisolone who were randomized to insulin glargine and insulin aspart vs insulin isophane and insulin aspart (30).…”

“…Although there are plausible mechanisms by which short-term hyperglycaemia might increase morbidity and mortality, such as inducing endothelial dysfunction and oxidative stress (29), data on major clinical endpoints are lacking. In our study, the inclusion criteria for hypoglycaemic therapy were one blood glucose level above 15 mmol/L or two blood glucose levels above 10 mmol/L within 24 h, to ensure subjects had either marked or sustained hyperglycaemia (30).…”

“…Two complementary randomized controlled studies have compared matched doses of isophane-based and glargine-based basal bolus insulin in patients on glucocorticoids (30,39). In both studies, 50% of the daily dose was administered as basal insulin and 50% as short-acting insulin with meals (30,39).…”

“…Two complementary randomized controlled studies have compared matched doses of isophane-based and glargine-based basal bolus insulin in patients on glucocorticoids (30,39). In both studies, 50% of the daily dose was administered as basal insulin and 50% as short-acting insulin with meals (30,39). Ruiz de Adana et al reported that in patients with type 2 diabetes and respiratory disease treated with methylprednisolone or deflazacort, there was no significant difference in glucose control between patients randomized to glargine-or isophane-based basal bolus insulin (39).…”

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

“…Aunque se ha aducido que el uso de NPH podría asociarse a un menor riesgo de hipoglucemias frente a insulina glargina o detemir 17 , en nuestro estudio, basado en una terapia basal-bolo, solo hubo una hipoglucemia grave en el grupo del PC, a pesar de las altas dosis de insulina administrada. Radhakutty et al, en su análisis de control glucémico los días 1 y 3 del ingreso aplicando una pauta basal-bolo versus insulina NPH, no observaron diferencias significativas ni en el control glucémico ni en la incidencia de hipoglucemias 19 . Otros estudios también han encontrado una eficacia similar entre NPH y pauta basal-bolo 16,18 .…”