Pattern of High‐Dose Prednisolone‐Induced Hyperglycaemia in COPD Exacerbations

Abstract

ABSTRACTBackgroundHigh‐dose prednisolone is the mainstay of treatment for acute exacerbations of chronic obstructive pulmonary disease (COPD). Hyperglycaemia is a dose‐related adverse effect of prednisolone. Recent evidence suggests that the presence of hyperglycaemia during COPD exacerbations may impair recovery. To develop a successful management strategy, more information is needed on the nature of prednisolone‐induced hyperglycaemia in COPD exacerbations.AimTo determine the characteristics of prednisolone‐induced hyperglycaemia in patients experiencing COPD exacerbations and receiving high‐dose prednisolone (20 mg or more daily).MethodA prospective study of patients hospitalised for COPD exacerbations and receiving high‐dose prednisolone. Eligible patients with COPD exacerbations and receiving highdose prednisolone were divided into 3 groups – diabetic, non‐diabetic and pre‐diabetic. The capillary blood glucose levels for the 3 groups were measured daily at 7 am, noon, 5 pm and 9 pm for up to 4 days of treatment. These blood glucose levels were compared with the retrospective blood glucose levels of diabetic patients hospitalised for reasons other than COPD exacerbations and not receiving prednisolone (control).ResultsCompared to the diabetic control group (n = 117), the mean daily blood glucose levels were 2 mmol/L higher in diabetic COPD patients receiving prednisolone (n = 7; p < 0.05). Pre‐diabetic COPD patients receiving prednisolone (n = 6), experienced a mean daily blood glucose level similar to that of the diabetic control group, while the non‐diabetic COPD patients (n = 6) were largely unaffected. In both diabetic and pre‐diabetic COPD patients there was a delayed blood glucose level peak at 5 pm that was 4 mmol/L higher than the 7 am blood glucose level (p < 0.05 for both). This pattern was not evident in the diabetic control group. In both the diabetic and pre‐diabetic COPD patients the recovery of blood glucose levels to baseline occurred within 24 hours.ConclusionPrednisolone‐induced hyperglycaemia influenced blood glucose levels in pre‐diabetic COPD patients to the same extent as diabetic COPD patients, while the non‐diabetic COPD patients were largely unaffected. The hyperglycaemic effect was transient, lasted for less than 24 hours and followed a distinct daily pattern.