Clinical determinants of insulin requirements during treatment of prednisolone-induced hyperglycaemia. (March 2023)

• Record Type: Journal Article
• Authors: Chen, Angela X.; Radhakutty, Anjana; Zimmermann, Anthony; Stranks, Stephen N.; Thompson, Campbell H.; Burt, Morton G.
• Is Part Of: Diabetes research and clinical practice. Volume 197(2023)
• Publication Date: 2023-03
• Subjects: Diabetes -- Glucocorticoids -- Hyperglycaemia -- Insulin therapy -- Prednisolone; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2023.110557
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Aims: The optimal treatment of prednisolone-associated hyperglycaemia is unclear, but guidelines recommend using a body weight-based daily insulin dose. This study evaluated how clinical variables were associated with insulin requirements in hospitalised patients with prednisolone-associated hyperglycaemia. Methods: In this prospective study, fifty adult inpatients who were taking prednisolone ≥20 mg/day and experienced hyperglycaemia were prescribed a 24-h intravenous insulin infusion. The daily insulin dose required to attain a mean glucose of 8 mmol/L was calculated. The associations between daily insulin dose and clinical variables were assessed. Results: The participants age was 69 ± 10 years, daily prednisolone dose was 34 ± 10 mg, HbA1c was 7.7 ± 2.0 % (61 ± 10 mmol/mol), 77 % had known type 2 diabetes and 30 % were female. In univariate analysis, weight was associated with daily insulin dose (r 2 = 0.11, p = 0.024). A multivariate model comprising sex, HbA1c, a prior diagnosis of diabetes, diabetes treatment and weight explained nearly-two thirds of the variability in daily insulin dose (r 2 = 0.65, p < 0.001). Conclusions: In patients with prednisolone-associated hyperglycaemia, calculating insulin doses based on sex, HbA1c, diabetes status and regular diabetes treatment and weight may improve glycaemic control compared to weight-based dosing.