P026 Sugar rush: single-centre audit of screening and counselling for steroid-induced hyperglycaemia, based on the British Society for Rheumatology giant cell arteritis guideline

Abstract

Abstract Background/Aims In patients starting steroids for giant cell arteritis (GCA), to evaluate adherence to BSR guideline: HbA1c monitoring, documentation of counselling, and detection of steroid-induced hyperglycaemia. Methods Data were gathered from the electronic medical records. Steroid-induced hyperglycaemia was defined as new HbA1c >48 measured 3+ months after beginning steroid treatment. The data were presented at a regional meeting to raise awareness and encourage clinicians to incorporate counselling and monitoring into their practice, and a GCA clinic was set up. Practice was then re-evaluated. Results In the baseline dataset, 60 patients with GCA had a mean age of 72; 47 were female; mean body mass index (BMI) was 27 (for the 39/60 with a recorded height and weight). Mean initial dose of prednisolone was 45.9mg. The re-audit cohort were comparable with a mean age of 73.1; 19 females and mean BMI of 27 (for 15/30 with recorded). Mean initial prednisolone dose of 46.3mg. Baseline HbA1c was checked in 32/60 (53%) initially, and 28/30 (93%) on re-audit. 7/60 (12%) had documentation of counselling for steroid-induced hyperglycaemia initially, which increased to 9/30 (30%) on re-audit. Hyperglycaemia was detected in 8/60 (13%) of the initial audit group, compared to 11/30 (36%) in the re-audit. In the initial cohort, 3/10 (30%) of those with diabetes at baseline developed hyperglycaemia and 4/12 (33%) of those with pre-diabetes at baseline developed hyperglycaemia. In the re-audit, 7/9 (78%) of those with diabetes at baseline developed hyperglycaemia and 4/7 (57%) with pre-diabetes at baseline developed hyperglycaemia. Those who developed hyperglycaemia had a higher baseline weight and BMI (Table 1) in both the initial cohort and re-audit. Conclusion The intervention improved monitoring for steroid-induced hyperglycaemia, improving detection rates. We identified patient counselling as a priority for future improvement work. Disclosure L.J. Blackmore: None. K.L. Devine: None. S.L. Mackie: Consultancies; On behalf of University of Leeds for AbbVie, AstraZeneca, Sanofi, Roche. Other; Support from Roche to attend EULAR2019.