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...
Autores principales: | , , , , , , , , |
---|---|
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 |