Endocrine Abstracts

Introduction: Steroids can precipitate significant hyperglycemia and Diabetes Mellitus in vulnerable populations including DM, pre-DM and the elderly. Steroid risks include deterioration in DM, glucose toxicity, HONK and HHS. This may be avoided by a simple screening HbA1c, which could prompt a ‘safeguard algorithm’ for the patients including instruction in glucose monitoring. The ‘at risk’ cohort is identified, and a surveillance regime is implemented.

Methods: We conducted a pilot study, assessing the prevalence of HbA1c screening pre- steroids commencement. This was a prospective study, identifying all patients (medical, surgical and oncological admissions/inpatients) in the BSH Cork, commencing oral steroids from July 19 – August 1, 2021. We reviewed if any had HbA1c screening within the preceding three months.

Results: Of all inpatients, 49 were commenced on steroids. 8/49 (16%) patients had an HbA1c measurement pre-treatment, ranging from 45-134 mmol/mol.

Discussion: The results highlight low level HbA1c testing pre steroids. 94% of steroid induced hyperglycemia develops within 48 hours of initiation (1), when most patients are still inpatients. 41/49 patients were not tested and are at risk for steroid induced hyperglycemia. Of those tested, all were in ‘at-risk category’ (HbA1c > 42mmol/mol). This may suggest a limitation in our study, in so far as, all those tested may have been known to be hyperglycaemic and the true screening value may be lower. Nonetheless, a simple HbA1c will identify those ‘at-risk’ for targeted glucose monitoring on steroids, ideally in hospital. This may minimize the risk of readmission and morbidity with HONK/HHS.

1. Fong AC, Cheung NW. The high incidence of steroid-induced hyperglycaemia in hospital. Diabetes Res Clin Pract. 2013;