SUN-163 Implementation of a Protocol for the Management of Steroid-Induced Hyperglycemia

Implementation of a Protocol for the Management of Steroid-Induced Hyperglycemia Background: Hyperglycemia is a recognized complication of supra-physiological steroid dosing. Such hyperglycemia can be of concern in hospitalized patients as it is linked with increased length of stay and mortality(1). There are no consensus guidelines on optimal treatment of steroid-induced hyperglycemia. The aim of this study was to assess the safety of a weight based insulin algorithm for persons treated with supra-physiological doses of steroids to examine the efficacy of using this algorithm in patients with diabetes treated with prednisone or methylprednisolone. Methods: All participants were admitted to medicine units with a known diagnosis of diabetes mellitus or Hemoglobin A1c over 6.5% who were prescribed at least 7.5mg of prednisone or methylprednisolone daily with two episodes of hyperglycemia (Blood glucose (BG)>200mg/dL) within 24 hours of steroid administration. Patients were excluded if they did not have at least 8 BG values after enrollment in the protocol. Two main analyses were conducted: 1) a comparison between control and protocol groups in terms of the proportion of high BG readings (i.e.BG>200) using generalized estimating equations (GEE) logistic regression and 2) a comparison between pre- and post-protocol BG readings in protocol patients who started protocol more than 48 hours after first steroid administration using Wilcoxon’s exact signed rank test. A result was statistically significant at the p<0.05 level of significance. All analyses were performed using SAS version 9.4(SAS Institute, Cary, NC). Results: A total of 51 patients were analyzed: 25 controls (before implementation of hyperglycemia protocol) and 26 protocol patients (after implementation of hyperglycemia protocol). The mean proportion of high BG readings in the control group was 70% vs. 62% in the protocol group; there was not enough evidence to conclude the proportion of high BG readings differed between the groups (p=0.18). The mean glucose levels had minimal differences between the two groups (mean BG=253mg/dL vs. 232mg/dL, respectively; p=0.10). In the protocol group, pre and post initiation of the protocol, the proportion of high BG readings decreased (p=0.053), ranging from 33% to 62% decrease, with a mean of 44% decrease. There were no episodes of hypoglycemia in those who received the protocol. Conclusion: There was evidence to suggest the proportion of BG>200mg/dL was lower after protocol initiation compared to before protocol initiation (p=0.053). The time to reach euglycemia was not immediate, as a result a more aggressive insulin dosing algorithm will be used for future studies. 1 Tamez-Pérez HE, Quintanilla-Flores DL, Rodríguez-Gutiérrez R, et al. Steroid hyperglycemia: prevalence, early detection and therapeutic recommendations: a narrative review. World J Diabetes 2015;6:1073–81.