Efficacy of a basal bolus insulin protocol to treat prednisolone‐induced hyperglycaemia in hospitalised patients. Issue 3 (March 2015)

• Record Type: Journal Article
• Authors: Burt, M. G.; Drake, S. M.; Aguilar‐Loza, N. R.; Esterman, A.; Stranks, S. N.; Roberts, G. W.
• Is Part Of: Internal medicine journal. Volume 45:Issue 3(2015)
• Page Start: 261
• Page End: 266
• Publication Date: 2015-03
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12680
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj12680-sec-0001" sec-type="section"> <title>Background/Aim</title> <p>Few studies have specifically investigated treatment of prednisolone‐induced hyperglycaemia.</p> </sec> <sec id="imj12680-sec-9001" sec-type="section"> <title>Aim</title> <p>To determine if a basal bolus insulin (BBI) protocol for inpatient hyperglycaemia is effective in patients prescribed acute prednisolone for an inflammatory disease.</p> </sec> <sec id="imj12680-sec-0002" sec-type="section"> <title>Methods</title> <p>In a cross‐sectional study, 66 patients with type 2 diabetes admitted to a general medical ward and treated with BBI for up to 5 days were studied. Twenty‐four patients were taking prednisolone ≥10 mg/day to treat an acute inflammatory disease. The remaining 42 patients were a control group. The primary outcome was mean daily blood glucose level.</p> </sec> <sec id="imj12680-sec-0003" sec-type="section"> <title>Results</title> <p>There were no significant differences in glycosylated haemoglobin (8.1 ± 1.0 vs 8.1 ± 1.6%, <italic>P</italic> = 0.88), age (77 ± 11 vs 75 ± 14 years, <italic>P</italic> = 0.57), male sex (63 vs 60%, <italic>P</italic> = 0.81) or body mass index (30.0 ± 5.3 vs 30.2 ± 11.5 kg/m<sup>2</sup>, <italic>P</italic> = 0.90) between patients taking prednisolone and controls. Mean daily glucose concentration was higher in patients taking prednisolone than in controls (12.2 ± 0.3 vs 10.0 ± 0.1 mmol/L, <italic>P</italic> < 0.001). Blood glucose level was higher in patients on prednisolone at 1700 h (14.6 ± 0.6 vs 10.3 ± 0.3 mmol/L, <italic>P</italic> < 0.001) and 2100 h (14.5 ± 0.6 vs 10.5 ± 0.3 mmol/L, <italic>P</italic> < 0.001), with no significant differences at 0700 h and 1200 h. These findings occurred despite patients taking prednisolone receiving a higher daily insulin dose than controls (0.67–0.70 vs 0.61–0.65 U/kg, <italic>P</italic> = 0.001) because of higher doses of ultra‐rapid‐acting insulin at 1200 h and 1700 h.</p> </sec> <sec id="imj12680-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Hospitalised patients taking prednisolone had substantial afternoon and evening hyperglycaemia despite receiving BBI via a protocol for inpatient hyperglycaemia. Specific insulin regimens for prednisolone‐induced hyperglycaemia are needed that recommend more insulin during this time period.</p> </sec> </abstract>