Endocrine Abstracts

Systemically administered glucocorticoids are known to cause hyperglycaemia, however there is a paucity of literature on the true prevalence, predictors or clinical impact of glucocorticoid-induced hyperglycaemia in hospital in-patients.

This study examined glucocorticoid-induced hyperglycaemia in patients receiving >25 mg prednisolone; or >8 mg dexamethasone; or equivalent, for any indication over a 3 month period.

64 consecutive in-patients were studied. All had fasting and pre-prandial capillary glucose levels measured for 48 hours. Hyperglycaemia was defined as at least 2 glucose levels within the diabetic range (fasting ≥7.0 mmol/l or random ≥11.1 mmol/l). Admission diagnoses were grouped as respiratory (53%), intra-cranial pathology (19%) or other (28%).

Of the 64 patients, 14 had a prior history of diabetes. Overall 27 (42%) were hyperglycaemic. These patients were older (65.9±14.0 vs 55.6±21.1 years; P=0.03), had a longer hospital stay (15.9±17.6 vs 9.2±7.7 days; P=0.04), were more likely to have pre-existing diabetes (44% vs 5%; P<0.001), less likely to have intra-cranial pathology (7% vs 27%; P=0.01) and had a non-significant trend towards a higher likelihood of prior use of glucocorticoids (44% vs 24%; P=0.1).

Of the 50 without known diabetes, 15 (30%) were hyperglycaemic. These patients were older (68.3±16.4 vs 55.2±21.2 years; P=0.04) and were more likely to have respiratory disease (80% vs 46%; P=0.04). Only 2 (13%) received any form of hypoglycaemic therapy.

Nearly half (47%) of patients admitted with a respiratory illness were hyperglycaemic. They had longer hospital stays (11.5±9.2 vs 6.1±5.1 days; P=0.04), however age; gender and prior glucocorticoid use did not differ significantly between those with or without hyperglycaemia.

Marked glucocorticoid-induced hyperglycaemia including in those without a history of diabetes is common and is associated with longer hospital stays. It occurs particularly in older patients with respiratory disease. Studies to determine the benefit of intervention are urgently required.