MON-650 Glucocorticoid- Induced Hyperglycemia, Higher Mortality and Morbidity? a Retrospective Analysis

Introduction: Glucocorticoid (GC)-induced hyperglycemia is a frequent side effect in hospitalized patients. Guidelines recommend treat-to-target treatment between 6-10 mmol/l with insulin, but patient-specific outcome has not been well-studied. Methods: In this retrospective data analysis, all patient records of a Medical University Clinic from January 2014 to April 2018 were screened for GC administration. We investigated the incidence of hyperglycemia in hospitalized patients after administration of at least 10 mg prednisolone equivalents daily and a minimal length of stay of 3 days. The primary combined endpoint consisted of mortality, cardiovascular events, and infections until 30 days after admission. Results: 2424 hospitalized patients received systemic GCs and met the inclusion criteria, of which 511 patients (21%) had an underlying diagnosis of diabetes. The overall incidence for GC-induced hyperglycemia was 33.5% (812 patients) and 3.7% of patients (n=89) had at least one documented hypoglycemia during the hospital stay. Compared to normoglycemic patients, GC-induced hyperglycemia was associated with a 40% increase in the risk for the combined primary endpoint (unadjusted odds ratio 1.39, 95%CI 1.16-1.66). This was also true after adjusting the analysis for age, Charlson comorbidity index and GC dose (adjusted odds ratio 1.68, 95% CI 1.25-2.26). Hypoglycemia was also associated with a doubling in the risk for the combined primary endpoint (odds ratio 1.95, 95% CI 1.2-3.17). Discussion/Conclusion: Mortality, cardiovascular events and rate of infections were markedly higher in patients with GC-induced hyperglycemia compared to normoglycemic patients. Hypoglycemia was infrequent, but also associated with higher risk for adverse outcome. Future studies should evaluate whether glucose control with novel treatment modalities has a beneficial effect on clinical outcomes in patients with GC-induced hyperglycemia.