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Insulin management in hospitalized patients with diabetes mellitus on high-dose glucocorticoids: Management of steroid-exacerbated hyperglycemia.
Cheng, Yu-Chien; Guerra, Yannis; Morkos, Michael; Tahsin, Bettina; Onyenwenyi, Chioma; Fogg, Louis; Fogelfeld, Leon.
  • Cheng YC; Division of Endocrinology, John H. Stroger. Jr. Hospital of Cook County, Chicago, Illinois, United States of America.
  • Guerra Y; Section of Endocrinology, Rush University Medical Center, Chicago, Illinois, United States of America.
  • Morkos M; Division of Endocrinology, John H. Stroger. Jr. Hospital of Cook County, Chicago, Illinois, United States of America.
  • Tahsin B; Section of Endocrinology, Rush University Medical Center, Chicago, Illinois, United States of America.
  • Onyenwenyi C; Division of Endocrinology, John H. Stroger. Jr. Hospital of Cook County, Chicago, Illinois, United States of America.
  • Fogg L; Section of Endocrinology, Rush University Medical Center, Chicago, Illinois, United States of America.
  • Fogelfeld L; Division of Endocrinology, John H. Stroger. Jr. Hospital of Cook County, Chicago, Illinois, United States of America.
PLoS One ; 16(9): e0256682, 2021.
Article in English | MEDLINE | ID: covidwho-1416872
ABSTRACT

BACKGROUND:

Glucocorticoid (GC)-exacerbated hyperglycemia is prevalent in hospitalized patients with diabetes mellitus (DM) but evidence-based insulin guidelines in inpatient settings are lacking. METHODS AND

FINDINGS:

Retrospective cohort study with capillary blood glucose (CBG) readings and insulin use, dosed with 50% basal (glargine)-50% bolus (lispro) insulin, analyzed in hospitalized patients with insulin-treated DM given GC and matched controls without GC (n = 131 pairs). GC group (median daily prednisone-equivalent dose 53.36 mg (IQR 30.00, 80.04)) had greatest CBG differences compared to controls at dinner (254±69 vs. 184±63 mg/dL, P<0.001) and bedtime (260±72 vs. 182±55 mg/dL, P<0.001). In GC group, dinner CBG was 30% higher than lunch (254±69 vs. 199±77 mg/dL, P<0.001) when similar lispro to controls given at lunch. Bedtime CBG not different from dinner when 20% more lispro given at dinner (0.12 units/kg (IQR 0.08, 0.17) vs. 0.10 units/kg (0.06, 0.14), P<0.01). Despite receiving more lispro, bedtime hypoglycemic events were lower in GC group (0.0% vs. 5.9%, P = 0.03).

CONCLUSIONS:

Since equal bolus doses inadequately treat large dinner and bedtime GC-exacerbated glycemic excursions, initiating higher bolus insulin at lunch and dinner with additional enhanced GC-specific insulin supplemental scale may be needed as initial insulin doses in setting of high-dose GC.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Blood Glucose / Diabetes Mellitus / Glucocorticoids / Hyperglycemia / Hypoglycemic Agents / Insulin Type of study: Cohort study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pone.0256682

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Blood Glucose / Diabetes Mellitus / Glucocorticoids / Hyperglycemia / Hypoglycemic Agents / Insulin Type of study: Cohort study / Observational study / Prognostic study Limits: Aged / Female / Humans / Male / Middle aged Country/Region as subject: North America Language: English Journal: PLoS One Journal subject: Science / Medicine Year: 2021 Document Type: Article Affiliation country: Journal.pone.0256682