Endocrine Abstracts

Introduction: Glucocorticoid use is well-known to exacerbate uncontrolled blood sugar levels in patients with known diabetes and worsen glycemic control in non-diabetics. Steroid induced hyperglycemia (SIH) is one of the most prevalent side effects with approximately 18-52% of patients experiencing it following steroid initiation [1]. There is a lack of guidance for SIH in Tipperary University Hospital (TUH) which prompted this audit. Our aims were to identify whether SIH was being screened for and recognize what treatment plans were being initiated.

Methods: Patients treated with steroids were identified via the TUH Hospital in-patient Enquiry (HIPE) database, between September 2021 and 2022. The charts were examined retrospectively to evaluate whether these patients were identified and subsequently managed for SIH. We audited the patient notes, drug and insulin prescribing charts, to establish their diabetes status, treatments given, whether blood glucose levels (BGL) were monitored, and if endocrine services were consulted. No personal identifiers were recorded.

Results: Twenty-six patients’ charts were recruited. Thirteen people had pre-existing diabetes, who were predominantly (77%) type-2 diabetics. Only fourteen (54%) patients on steroids had their BGL monitored whilst their steroids were initiated, with ten of them (71%) developing SIH. Among the diabetics, all received BGL monitoring after steroids were initiated, while only one non-diabetic had their BGL monitored. Pre-meal insulin supplementary scale was the most common intervention employed, with only twelve (46%) patients being referred to endocrine.

Conclusion: SIH is common but often missed. Its diagnosis is potentially harmful as it leads to poor wound healing, increased rates of hospital-based infections and mortality, which should motivate healthcare workers to monitor its occurrence and manage it appropriately. Deviation in practice exists due to lack in formal local guidance, and this audit provides a starting point for further quality improvement projects.