The high incidence of steroid-induced hyperglycaemia in hospital

Aim: The objective of this study was to systematically evaluate the incidence of steroid-induced hyperglycaemia in a tertiary referral hospital. We conducted a glucometric audit of a prospective protocol where glucose monitoring was routinely performed on patients treated with high-dose steroids. Methods: The protocol specified routine fingerprick glucose monitoring for patients commencing high-dose steroid therapy (prednisone 25 mg/day, dexamethasone 4 mg/day, hydrocortisone 100 mg/day, or more) for a minimum of 48 h. The medical records and charts of these patients were audited after a 6 month period. Results: There were 80 non-diabetic patients treated with high-dose steroids and 862 blood glucose (BG) readings were recorded. The mean BG was >= 8 mmol/L in 38 (48%) patients and >= 10 mmol/L in 11 (14%) subjects. Sixty-nine (86%) subjects had at least one BG >= 8 mmol/L, and 56 (70%) subjects had at least one BG >= 10 mmol/L. Among those with hyperglycaemia, it had developed within 48 h in 94% of subjects. When prednisone was administered as a once daily morning dose, glucose levels peaked in the afternoon, and would return to baseline by the next morning. Conclusions: We conclude that steroid-induced hyperglycaemia is common in hospital. Patients should be monitored for hyperglycaemia upon commencement of high-dose steroid therapy and treatment commenced as indicated. Crown Copyright (C) 2012 Published by Elsevier Ireland Ltd. All rights reserved.