Endocrine Abstracts

Introduction: High-dose glucocorticoid therapy is a recognized cause of hyperglycemia. Given the paucity of literature regarding the incidence of glucocorticoid-induced hyperglycemia among nondiabetic patients, we commenced this study in order to assess its incidence and to identify risk factors.

Design: A retrospective longitudinal cohort study.

Methods: We retrieved patients over 18 years old, without prior diabetes diagnosis or treatment who were hospitalized in Rambam Health Care Campus between 1.1.2012 – 31.3.2017, and received ≥10 mg oral prednisone or equivalent intravenous hydrocortisone or intravenous dexamethasone, for at least 2 days. Demographic and laboratory values of patients who developed hyperglycemia (defined by ≥ 1 capillary blood glucose ≥ 180 mg/dl during the first 4 days of glucocorticoid treatment) were compared to those of patients who did not develop hyperglycemia.

Results: There were 671 patients who filled the inclusion criteria: 355 received oral prednisone, 164 received intravenous dexamethasone, and 152 received intravenous hydrocortisone. The incidence of glucocorticoid-induced hyperglycemia among all patients was 22.6%. Patients who developed glucocorticoid-induced hyperglycemia were older and had a higher creatinine, BUN and WBC count. Using multivariate regression analysis, age over 80 years (OR: 6.27, 95% CI 3.02-13.05), hospitalization in non-surgical wards (OR: 3.08, 95% CI 1.64–5.81), and a 4-day cumulative prednisone dose > 240 mg (OR: 1.78, 95% CI 1.2–2.64), were identified as independent risk factors for hyperglycemia.

Conclusion: Older patients without prior diabetes receiving high doses of glucocorticoids should be monitored closely for the development of glucocorticoid-induced hyperglycemia. Special attention should be paid to patients receiving over 60 mg prednisone/day and patients hospitalized in non-surgical departments.