Cargando…

Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids

High dose steroids (HDS) are used in the treatment of haematological malignancies. The reported risk of steroid-induced diabetes (SID) is high. However, screening is not consistently performed. We implemented a protocol for detection and management of SID and steroid-induced hyperglycamia (SIH) in h...

Descripción completa

Detalles Bibliográficos
Autores principales: Vidler, Jennifer, Rogers, Charlotte, Yallop, Deborah, Devereux, Stephen, Wellving, Ellinor, Stewart, Orla, Cox, Alison, Hunt, Katharine F., Kassam, Shireen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651285/
https://www.ncbi.nlm.nih.gov/pubmed/29067264
http://dx.doi.org/10.1016/j.jcte.2017.06.003
_version_ 1783272864291487744
author Vidler, Jennifer
Rogers, Charlotte
Yallop, Deborah
Devereux, Stephen
Wellving, Ellinor
Stewart, Orla
Cox, Alison
Hunt, Katharine F.
Kassam, Shireen
author_facet Vidler, Jennifer
Rogers, Charlotte
Yallop, Deborah
Devereux, Stephen
Wellving, Ellinor
Stewart, Orla
Cox, Alison
Hunt, Katharine F.
Kassam, Shireen
author_sort Vidler, Jennifer
collection PubMed
description High dose steroids (HDS) are used in the treatment of haematological malignancies. The reported risk of steroid-induced diabetes (SID) is high. However, screening is not consistently performed. We implemented a protocol for detection and management of SID and steroid-induced hyperglycamia (SIH) in haematology outpatients receiving HDS. Eighty-three people were diagnosed with a lymphoproliferative disorder, of whom 6 had known Type 2 diabetes. Fifty-three people without known diabetes were screened by HbA1c and random venous plasma glucose. All patients (n = 34) subsequently prescribed HDS checked capillary blood glucose (CBG) pre-breakfast and pre-evening meal. Treatment algorithms used initiation and/or dose titration of gliclazide or human NPH insulin, aiming for pre-meal CBG 5–11 mmol/l. Type 2 diabetes was identified in 4/53 people screened (7.5%). Of 34 people treated with HDS, 17 (44%) developed SIH/SID. All 7 people with Type 2 diabetes developed SIH and 3 required insulin. Of 27 people without known diabetes, 8 (30%) developed SID and 1 required insulin. Pre-treatment HbA1c was higher in people who developed SID compared to those that did not (p = 0.002). This is the first report of a SID/SIH detection and treatment protocol for use in people with lymphoproliferative disorders receiving intermittent HDS, demonstrating its feasibility and safety.
format Online
Article
Text
id pubmed-5651285
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-56512852017-10-24 Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids Vidler, Jennifer Rogers, Charlotte Yallop, Deborah Devereux, Stephen Wellving, Ellinor Stewart, Orla Cox, Alison Hunt, Katharine F. Kassam, Shireen J Clin Transl Endocrinol Research Paper High dose steroids (HDS) are used in the treatment of haematological malignancies. The reported risk of steroid-induced diabetes (SID) is high. However, screening is not consistently performed. We implemented a protocol for detection and management of SID and steroid-induced hyperglycamia (SIH) in haematology outpatients receiving HDS. Eighty-three people were diagnosed with a lymphoproliferative disorder, of whom 6 had known Type 2 diabetes. Fifty-three people without known diabetes were screened by HbA1c and random venous plasma glucose. All patients (n = 34) subsequently prescribed HDS checked capillary blood glucose (CBG) pre-breakfast and pre-evening meal. Treatment algorithms used initiation and/or dose titration of gliclazide or human NPH insulin, aiming for pre-meal CBG 5–11 mmol/l. Type 2 diabetes was identified in 4/53 people screened (7.5%). Of 34 people treated with HDS, 17 (44%) developed SIH/SID. All 7 people with Type 2 diabetes developed SIH and 3 required insulin. Of 27 people without known diabetes, 8 (30%) developed SID and 1 required insulin. Pre-treatment HbA1c was higher in people who developed SID compared to those that did not (p = 0.002). This is the first report of a SID/SIH detection and treatment protocol for use in people with lymphoproliferative disorders receiving intermittent HDS, demonstrating its feasibility and safety. Elsevier 2017-06-24 /pmc/articles/PMC5651285/ /pubmed/29067264 http://dx.doi.org/10.1016/j.jcte.2017.06.003 Text en © 2017 The Authors. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Research Paper
Vidler, Jennifer
Rogers, Charlotte
Yallop, Deborah
Devereux, Stephen
Wellving, Ellinor
Stewart, Orla
Cox, Alison
Hunt, Katharine F.
Kassam, Shireen
Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids
title Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids
title_full Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids
title_fullStr Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids
title_full_unstemmed Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids
title_short Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids
title_sort outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids
topic Research Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5651285/
https://www.ncbi.nlm.nih.gov/pubmed/29067264
http://dx.doi.org/10.1016/j.jcte.2017.06.003
work_keys_str_mv AT vidlerjennifer outpatientmanagementofsteroidinducedhyperglycaemiaandsteroidinduceddiabetesinpeoplewithlymphoproliferativedisorderstreatedwithintermittenthighdosesteroids
AT rogerscharlotte outpatientmanagementofsteroidinducedhyperglycaemiaandsteroidinduceddiabetesinpeoplewithlymphoproliferativedisorderstreatedwithintermittenthighdosesteroids
AT yallopdeborah outpatientmanagementofsteroidinducedhyperglycaemiaandsteroidinduceddiabetesinpeoplewithlymphoproliferativedisorderstreatedwithintermittenthighdosesteroids
AT devereuxstephen outpatientmanagementofsteroidinducedhyperglycaemiaandsteroidinduceddiabetesinpeoplewithlymphoproliferativedisorderstreatedwithintermittenthighdosesteroids
AT wellvingellinor outpatientmanagementofsteroidinducedhyperglycaemiaandsteroidinduceddiabetesinpeoplewithlymphoproliferativedisorderstreatedwithintermittenthighdosesteroids
AT stewartorla outpatientmanagementofsteroidinducedhyperglycaemiaandsteroidinduceddiabetesinpeoplewithlymphoproliferativedisorderstreatedwithintermittenthighdosesteroids
AT coxalison outpatientmanagementofsteroidinducedhyperglycaemiaandsteroidinduceddiabetesinpeoplewithlymphoproliferativedisorderstreatedwithintermittenthighdosesteroids
AT huntkatharinef outpatientmanagementofsteroidinducedhyperglycaemiaandsteroidinduceddiabetesinpeoplewithlymphoproliferativedisorderstreatedwithintermittenthighdosesteroids
AT kassamshireen outpatientmanagementofsteroidinducedhyperglycaemiaandsteroidinduceddiabetesinpeoplewithlymphoproliferativedisorderstreatedwithintermittenthighdosesteroids