Efficacy Of A Basal Bolus Insulin Protocol To Treat Prednisolone-Induced Hyperglycaemia In Hospitalized Patients.

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Efficacy Of A Basal Bolus Insulin Protocol To Treat Prednisolone-Induced Hyperglycaemia In Hospitalized Patients.

Intern Med J. 2015 Jan 6;

Authors: Burt MG, Drake SM, Aguilar-Loza NR, Esterman A, Stranks SN, Roberts GW

Abstract
BACKGROUND: Few studies have specifically investigated treatment of prednisolone-induced hyperglycaemia.
AIMS: The aim was to determine if a basal-bolus insulin (BBI) protocol for inpatient hyperglycaemia is effective in patients prescribed acute prednisolone for an inflammatory disease.
METHODS: In a cross-sectional study, 66 patients with type 2 diabetes admitted to a general medical ward and treated with BBI for up to 5 days were studied. Twenty-four patients were taking prednisolone ≥10 mg/day to treat an acute inflammatory disease. The remaining 42 patients were a control group. The primary outcome was mean daily blood glucose level (BGL).
RESULTS: There were no significant differences in glycosylated hemoglobin (8.1±1.0 vs 8.1±1.6%, p=0.88), age (77±11 vs 75±14 years, p=0.57), male sex (63 vs 60%, p=0.81), or BMI (30.0±5.3 vs 30.2±11.5 kg/m(2) , p=0.90) between patients taking prednisolone and controls. Mean daily glucose concentration was higher in patients taking prednisolone than in controls (12.2±0.3 vs 10.0±0.1 mmol/L, p<0.001). BGLs were higher in patients on prednisolone at 1700 (14.6±0.6 vs 10.3±0.3 mmol/L, p<0.001) and 2100 (14.5±0.6 vs 10.5±0.3 mmol/L, p<0.001) hours, with no significant differences at 0700 and 1200 hours. These findings occurred despite patients taking prednisolone receiving a higher daily insulin dose than controls (0.67-0.70 vs 0.61-0.65 U/kg, p=0.001) because of higher doses of ultra-rapid-acting insulin at 1200 and 1700 hours.
CONCLUSIONS: Hospitalized patients taking prednisolone had substantial afternoon and evening hyperglycaemia despite receiving BBI via a protocol for inpatient hyperglycaemia. Specific insulin regimens for prednisolone-induced hyperglycaemia are needed that recommend more insulin during this time period.

PMID: 25565560 [PubMed - as supplied by publisher]

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