Cargando…
Management of hyperglycaemia in persons with non-insulin-dependent type 2 diabetes mellitus who are started on systemic glucocorticoid therapy: a systematic review
OBJECTIVES: What is the most effective pharmacological intervention for glycaemic control in known type 2 diabetes mellitus (DM) without prior insulin treatment and newly started on systemic glucocorticoid therapy? DESIGN: We conducted a systematic literature review. DATA SOURCES: We searched MEDLIN...
Autores principales: | , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549610/ https://www.ncbi.nlm.nih.gov/pubmed/31154314 http://dx.doi.org/10.1136/bmjopen-2019-028914 |
_version_ | 1783424043283644416 |
---|---|
author | Tatalovic, Milos Lehmann, Roger Cheetham, Marcus Nowak, Albina Battegay, Edouard Rampini, Silvana K |
author_facet | Tatalovic, Milos Lehmann, Roger Cheetham, Marcus Nowak, Albina Battegay, Edouard Rampini, Silvana K |
author_sort | Tatalovic, Milos |
collection | PubMed |
description | OBJECTIVES: What is the most effective pharmacological intervention for glycaemic control in known type 2 diabetes mellitus (DM) without prior insulin treatment and newly started on systemic glucocorticoid therapy? DESIGN: We conducted a systematic literature review. DATA SOURCES: We searched MEDLINE, Embase and Cochrane Library databases and Google for articles from 2002 to July 2018. ELIGIBILITY CRITERIA: We combined search terms relating to DM (patients, >16 years of age), systemic glucocorticoids, glycaemic control, randomised controlled trials (RCTs) and observational studies. DATA EXTRACTION AND SYNTHESIS: We screened and evaluated articles, extracted data and assessed risk of bias and quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation guidelines. RESULTS: Eight of 2365 articles met full eligibility criteria. Basal-bolus insulin (BBI) strategy for patients under systemic glucocorticoid therapy was comparatively effective but provided insufficient glucose control, depending on time of day. BBI strategy with long-acting insulin and neutral protamin Hagedorn as basal insulin provided similar overall glycaemic control. Addition of various insulin strategies to standard BBI delivered mixed results. Intermediate-acting insulin (IMI) as additional insulin conferred no clear benefits, and glycaemic control with sliding scale insulin was inferior to BBI or IMI. No studies addressed whether anticipatory or compensatory insulin adjustments are better for glycaemic control. CONCLUSION: The lack of suitably designed RCTs and observational studies, heterogeneity of interventions, target glucose levels and glucose monitoring, poor control of DM subgroups and low to moderate quality of evidence render identification of optimal pharmacological interventions for glycaemic control and insulin management difficult. Even findings on the widely recommended BBI regimen as intensive insulin therapy for patients with DM on glucocorticoids are inconclusive. High-quality evidence from studies with well-defined DM phenotypes, settings and treatment approaches is needed to determine optimal pharmacological intervention for glycaemic control. PROSPERO REGISTRATION NUMBER: CRD42015024739. |
format | Online Article Text |
id | pubmed-6549610 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-65496102019-06-21 Management of hyperglycaemia in persons with non-insulin-dependent type 2 diabetes mellitus who are started on systemic glucocorticoid therapy: a systematic review Tatalovic, Milos Lehmann, Roger Cheetham, Marcus Nowak, Albina Battegay, Edouard Rampini, Silvana K BMJ Open Diabetes and Endocrinology OBJECTIVES: What is the most effective pharmacological intervention for glycaemic control in known type 2 diabetes mellitus (DM) without prior insulin treatment and newly started on systemic glucocorticoid therapy? DESIGN: We conducted a systematic literature review. DATA SOURCES: We searched MEDLINE, Embase and Cochrane Library databases and Google for articles from 2002 to July 2018. ELIGIBILITY CRITERIA: We combined search terms relating to DM (patients, >16 years of age), systemic glucocorticoids, glycaemic control, randomised controlled trials (RCTs) and observational studies. DATA EXTRACTION AND SYNTHESIS: We screened and evaluated articles, extracted data and assessed risk of bias and quality of evidence according to Grading of Recommendations Assessment, Development and Evaluation guidelines. RESULTS: Eight of 2365 articles met full eligibility criteria. Basal-bolus insulin (BBI) strategy for patients under systemic glucocorticoid therapy was comparatively effective but provided insufficient glucose control, depending on time of day. BBI strategy with long-acting insulin and neutral protamin Hagedorn as basal insulin provided similar overall glycaemic control. Addition of various insulin strategies to standard BBI delivered mixed results. Intermediate-acting insulin (IMI) as additional insulin conferred no clear benefits, and glycaemic control with sliding scale insulin was inferior to BBI or IMI. No studies addressed whether anticipatory or compensatory insulin adjustments are better for glycaemic control. CONCLUSION: The lack of suitably designed RCTs and observational studies, heterogeneity of interventions, target glucose levels and glucose monitoring, poor control of DM subgroups and low to moderate quality of evidence render identification of optimal pharmacological interventions for glycaemic control and insulin management difficult. Even findings on the widely recommended BBI regimen as intensive insulin therapy for patients with DM on glucocorticoids are inconclusive. High-quality evidence from studies with well-defined DM phenotypes, settings and treatment approaches is needed to determine optimal pharmacological intervention for glycaemic control. PROSPERO REGISTRATION NUMBER: CRD42015024739. BMJ Publishing Group 2019-06-01 /pmc/articles/PMC6549610/ /pubmed/31154314 http://dx.doi.org/10.1136/bmjopen-2019-028914 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Diabetes and Endocrinology Tatalovic, Milos Lehmann, Roger Cheetham, Marcus Nowak, Albina Battegay, Edouard Rampini, Silvana K Management of hyperglycaemia in persons with non-insulin-dependent type 2 diabetes mellitus who are started on systemic glucocorticoid therapy: a systematic review |
title | Management of hyperglycaemia in persons with non-insulin-dependent type 2 diabetes mellitus who are started on systemic glucocorticoid therapy: a systematic review |
title_full | Management of hyperglycaemia in persons with non-insulin-dependent type 2 diabetes mellitus who are started on systemic glucocorticoid therapy: a systematic review |
title_fullStr | Management of hyperglycaemia in persons with non-insulin-dependent type 2 diabetes mellitus who are started on systemic glucocorticoid therapy: a systematic review |
title_full_unstemmed | Management of hyperglycaemia in persons with non-insulin-dependent type 2 diabetes mellitus who are started on systemic glucocorticoid therapy: a systematic review |
title_short | Management of hyperglycaemia in persons with non-insulin-dependent type 2 diabetes mellitus who are started on systemic glucocorticoid therapy: a systematic review |
title_sort | management of hyperglycaemia in persons with non-insulin-dependent type 2 diabetes mellitus who are started on systemic glucocorticoid therapy: a systematic review |
topic | Diabetes and Endocrinology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6549610/ https://www.ncbi.nlm.nih.gov/pubmed/31154314 http://dx.doi.org/10.1136/bmjopen-2019-028914 |
work_keys_str_mv | AT tatalovicmilos managementofhyperglycaemiainpersonswithnoninsulindependenttype2diabetesmellituswhoarestartedonsystemicglucocorticoidtherapyasystematicreview AT lehmannroger managementofhyperglycaemiainpersonswithnoninsulindependenttype2diabetesmellituswhoarestartedonsystemicglucocorticoidtherapyasystematicreview AT cheethammarcus managementofhyperglycaemiainpersonswithnoninsulindependenttype2diabetesmellituswhoarestartedonsystemicglucocorticoidtherapyasystematicreview AT nowakalbina managementofhyperglycaemiainpersonswithnoninsulindependenttype2diabetesmellituswhoarestartedonsystemicglucocorticoidtherapyasystematicreview AT battegayedouard managementofhyperglycaemiainpersonswithnoninsulindependenttype2diabetesmellituswhoarestartedonsystemicglucocorticoidtherapyasystematicreview AT rampinisilvanak managementofhyperglycaemiainpersonswithnoninsulindependenttype2diabetesmellituswhoarestartedonsystemicglucocorticoidtherapyasystematicreview |