The high incidence of steroid-induced hyperglycaemia in hospital

Abstract

AimThe objective of this study was to systematically evaluate the incidence of steroid-induced hyperglycaemia in a tertiary referral hospital. We conducted a glucometric audit of a prospective protocol where glucose monitoring was routinely performed on patients treated with high-dose steroids. MethodsThe protocol specified routine fingerprick glucose monitoring for patients commencing high-dose steroid therapy (prednisone 25mg/day, dexamethasone 4mg/day, hydrocortisone 100mg/day, or more) for a minimum of 48h. The medical records and charts of these patients were audited after a 6 month period. ResultsThere were 80 non-diabetic patients treated with high-dose steroids and 862 blood glucose (BG) readings were recorded. The mean BG was ≥8mmol/L in 38 (48%) patients and ≥10mmol/L in 11 (14%) subjects. Sixty-nine (86%) subjects had at least one BG ≥8mmol/L, and 56 (70%) subjects had at least one BG ≥10mmol/L. Among those with hyperglycaemia, it had developed within 48h in 94% of subjects. When prednisone was administered as a once daily morning dose, glucose levels peaked in the afternoon, and would return to baseline by the next morning. ConclusionsWe conclude that steroid-induced hyperglycaemia is common in hospital. Patients should be monitored for hyperglycaemia upon commencement of high-dose steroid therapy and treatment commenced as indicated.