Monitoring and management of inpatients on systemic glucocorticoids - quality improvement for inpatient care

Fuller Eoin Stephen; O; Kyithar Ma Pyeh

doi:10.1530/endoabs.104.P80

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Endocrine Abstracts (2024) 104 P80 | DOI: 10.1530/endoabs.104.P80

SFEIES24 Poster Presentations Diabetes & Metabolism (68 abstracts)

Monitoring and management of inpatients on systemic glucocorticoids – quality improvement for inpatient care

Eoin Stephen Fuller ¹ , Kate Mary O’Shea ¹ & Ma Pyeh Kyithar ^2,3

Err

Author affiliations

¹University College Dublin Intern Network, Dublin, Ireland; ²Department of Diabetes, Endocrinology and Internal Medicine, Midland Regional Hospital Portlaoise, Laois, Ireland; ³School of Medicine, Trinity College Dublin, Dublin, Ireland

Background: Blood glucose monitoring for inpatients on systemic glucocorticoids is recommended by The Joint British Diabetes Societies for Inpatient Care, due to increased insulin resistance. Stress dosing of steroids during acute illness is recommended by the Society of Endocrinology in patients taking long-term systemic steroids due to the increased likelihood of suppressed hypothalamo-pituitary-adrenal function.

Aims: We aimed to determine whether capillary blood glucose (CBG) and HbA1c were measured in inpatients on systemic steroids, with and without a diagnosis of diabetes. We also assessed whether stress doses of steroids were given to inpatients on long term steroids admitted with acute illnesses.

Methods: A cross-sectional study was carried out in adult medical, surgical, and critical care wards in Midlands Regional Hospital Portlaoise in early May 2024.

Results: 9 of 81 inpatients (11%) were on systemic (oral and IV) glucocorticoids on the day of the study. Mean age of inpatients on steroids was 72.7±14.3 years. Of those on steroids, 78% had no known pre-existing diabetes. CBG monitoring was not performed in any of the inpatients on systemic steroids with no known diabetes. CBG monitoring was performed appropriately on all patients with known diabetes (n = 2). 22% of inpatients on systemic steroids had HbA1c measurements within a 3-month timeframe. Patients on long term steroids (n = 2) did not receive stress dose steroids during admission.

Conclusion: This study demonstrated blood glucose monitoring was not performed on inpatients on steroids without pre-existing diabetes although this cohort of patients were at risk for steroid-induced diabetes due to their age and co-morbidities. This audit also identified the knowledge gap among the hospital staff to administer stress doses of steroids for patients on long-term steroid therapy during acute illness. This highlights a need for ongoing education to staff and implementation of local policies together with the hospital pharmacy department.