OBJECTIVE: Steroid-induced hyperglycemia is common in hospitalized patients with diabetes mellitus. Guidelines for glucose management in this setting are lacking. METHODS: We conducted a retrospective chart review of non-critically ill patients with diabetes receiving steroids, hospitalized from January 2009 to October 2012. Fifty-eight patients were identified from 247 consults. Multivariable linear regression was used to assess median daily insulin requirements of normoglycemic patients compared with hyperglycemic patients. RESULTS: Of the 58 total patients included in our study, 20 achieved normoglycemia during admission (patient-day weighted mean blood glucose [PDWMBG] level = 154 ± 16 mg/dL) and 38 remained hyperglycemic (PDWMBG level = 243 ± 39 mg/dL; P < 0.001). There were no differences between the 2 patient groups in age, sex, race, body weight, renal function, HbA1c level, glucose-altering medications, diabetes type, or disease duration. Following multivariable adjustment, compared with hyperglycemic patients, normoglycemic patients required similar units of basal insulin (median interquartile range [IQR])(23.6 [17.9, 31.2] vs 20.1 [16.5, 24.4]; P = 0.35); higher units of nutritional insulin (45.5 [34.2, 60.4] vs 20.1 [16.4, 24.5]; P < 0.001]; and lower units of correctional insulin (5.8 [4.1, 8.1] vs 13.0 [10.2, 16.5]; P < 0.001]). Patients achieving normoglycemia required a significantly lower percentage of correction insulin (total daily dose [TDD]: 7.4% vs 23.4%; P < 0.001) and a higher percentage of nutritional insulin (TDD: 58.1% vs 36.2%; P <0.001) than hyperglycemic patients. There was no difference in the TDD per kilogram, TDD per milligram hydrocortisone dose, or TDD per milligram hydrocortisone dose per kilogram weight between the 2 groups. CONCLUSION: The data suggest that non-critically ill patients with hyperglycemia receiving steroids require a higher percentage of TDD insulin therapy as nutritional insulin to achieve normoglycemia.
OBJECTIVE:Steroid-induced hyperglycemia is common in hospitalized patients with diabetes mellitus. Guidelines for glucose management in this setting are lacking. METHODS: We conducted a retrospective chart review of non-critically ill patients with diabetes receiving steroids, hospitalized from January 2009 to October 2012. Fifty-eight patients were identified from 247 consults. Multivariable linear regression was used to assess median daily insulin requirements of normoglycemic patients compared with hyperglycemicpatients. RESULTS: Of the 58 total patients included in our study, 20 achieved normoglycemia during admission (patient-day weighted mean blood glucose [PDWMBG] level = 154 ± 16 mg/dL) and 38 remained hyperglycemic (PDWMBG level = 243 ± 39 mg/dL; P < 0.001). There were no differences between the 2 patient groups in age, sex, race, body weight, renal function, HbA1c level, glucose-altering medications, diabetes type, or disease duration. Following multivariable adjustment, compared with hyperglycemicpatients, normoglycemic patients required similar units of basal insulin (median interquartile range [IQR])(23.6 [17.9, 31.2] vs 20.1 [16.5, 24.4]; P = 0.35); higher units of nutritional insulin (45.5 [34.2, 60.4] vs 20.1 [16.4, 24.5]; P < 0.001]; and lower units of correctional insulin (5.8 [4.1, 8.1] vs 13.0 [10.2, 16.5]; P < 0.001]). Patients achieving normoglycemia required a significantly lower percentage of correction insulin (total daily dose [TDD]: 7.4% vs 23.4%; P < 0.001) and a higher percentage of nutritional insulin (TDD: 58.1% vs 36.2%; P <0.001) than hyperglycemicpatients. There was no difference in the TDD per kilogram, TDD per milligram hydrocortisone dose, or TDD per milligram hydrocortisone dose per kilogram weight between the 2 groups. CONCLUSION: The data suggest that non-critically ill patients with hyperglycemia receiving steroids require a higher percentage of TDD insulin therapy as nutritional insulin to achieve normoglycemia.
Authors: Stephen Clement; Susan S Braithwaite; Michelle F Magee; Andrew Ahmann; Elizabeth P Smith; Rebecca G Schafer; Irl B Hirsch; Irl B Hirsh Journal: Diabetes Care Date: 2004-02 Impact factor: 19.112
Authors: Jian-zhong Xiao; Li Ma; Jie Gao; Zhao-jun Yang; Xiao-yan Xing; Hong-chuan Zhao; Jin-song Jiao; Guang-wei Li Journal: Zhonghua Nei Ke Za Zhi Date: 2004-03
Authors: Guillermo E Umpierrez; Scott D Isaacs; Niloofar Bazargan; Xiangdong You; Leonard M Thaler; Abbas E Kitabchi Journal: J Clin Endocrinol Metab Date: 2002-03 Impact factor: 5.958
Authors: D P Rooney; R D Neely; C Cullen; C N Ennis; B Sheridan; A B Atkinson; E R Trimble; P M Bell Journal: J Clin Endocrinol Metab Date: 1993-11 Impact factor: 5.958
Authors: Michael F Nielsen; Andrea Caumo; Visvanathan Chandramouli; William C Schumann; Claudio Cobelli; Bernard R Landau; Hendrik Vilstrup; Robert A Rizza; Ole Schmitz Journal: Am J Physiol Endocrinol Metab Date: 2003-09-09 Impact factor: 4.310
Authors: Boris Draznin; Janice Gilden; Sherita H Golden; Silvio E Inzucchi; David Baldwin; Bruce W Bode; Jeffrey B Boord; Susan S Braithwaite; Enrico Cagliero; Kathleen M Dungan; Mercedes Falciglia; M Kathleen Figaro; Irl B Hirsch; David Klonoff; Mary T Korytkowski; Mikhail Kosiborod; Lillian F Lien; Michelle F Magee; Umesh Masharani; Gregory Maynard; Marie E McDonnell; Eti S Moghissi; Neda Rasouli; Daniel J Rubin; Robert J Rushakoff; Archana R Sadhu; Stanley Schwartz; Jane Jeffrie Seley; Guillermo E Umpierrez; Robert A Vigersky; Cecilia C Low; Deborah J Wexler Journal: Diabetes Care Date: 2013-07 Impact factor: 19.112