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Effect of high-dose dexamethasone on patients without diabetes during elective neurosurgery: a prospective study

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Abstract

Introduction

The peri-operative use of high-dose dexamethasone to reduce cerebral oedema may result in worsening glycaemic control in people with diabetes and glucocorticoid-induced diabetes in susceptible individuals. This study aims to examine the incidence of glucocorticoid-induced diabetes in a cohort of neurosurgical patients receiving high-dose dexamethasone peri-operatively.

Materials and methods

Adult non-diabetic neurosurgical patients receiving high-dose dexamethasone were prospectively studied. Exclusion criteria included pregnancy, HbA1c > 6.0%, and use of anti-diabetes therapies. The following data were collected: Family history of diabetes, body mass index, fasting glucose, insulin, C-peptide, and HbA1c (prior to surgery and 6 weeks after last dose of dexamethasone). Homeostatic model assessment values were calculated. Peri-operative glucose readings were recorded and 75 g oral glucose tolerance tests performed at the end of 6 weeks. Paired student t tests and multiple linear regressions were used.

Results

Data from 21 participants (11 women) were available. The mean total dose of dexamethasone was 96 ± 34 mg, and treatment duration was 17 ± 7 days. A total of 105 random blood glucose levels were documented peri-operatively (mean 7.0 ± 1.0 mmol/L). Six weeks following cessation of dexamethasone course, none of the participants developed diabetes, defined either by fasting glucose or by 75 g OGTT. There was a statistically significant increase in the mean HOMA-β from 81.5 to 102.1% (p = 0.01) and a significant decrease in the mean fasting glucose from 5.7 to 4.8 mmol/L (p = 0.001).

Conclusions

The use of high-dose dexamethasone in this cohort of neurosurgical patients did not result in glucocorticoid-induced diabetes. Hyperglycaemia was transient and had resolved by 6 weeks.

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Acknowledgements

The authors would like to thank the nursing staff at Ward 2 and the Neurosurgeons working at Macquarie University Hospital for their help in recruiting the patients. Also, many thanks to Douglas-Hanley Moir Pathology for their help in performing the blood tests.

Funding

This research did not receive any specific grant from any funding agency.

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Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, Macquarie University, Ground Floor, 75 Talevera Road, Macquarie Park, NSW, 2109, Australia

    Majid Alabbood, Min Ling & Kenneth Ho

Authors
  1. Majid Alabbood
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  2. Min Ling
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  3. Kenneth Ho
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Contributions

MA recruited the participants, performed the statistical analysis and drafted the manuscript. KH designed the study, reviewed and edited the manuscript. ML reviewed and edited the manuscript.

Corresponding author

Correspondence to Majid Alabbood.

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Conflict of interest

The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent or substitute for it was obtained from all patients for being included in the study.

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Alabbood, M., Ling, M. & Ho, K. Effect of high-dose dexamethasone on patients without diabetes during elective neurosurgery: a prospective study. Diabetol Int 10, 109–116 (2019). https://doi.org/10.1007/s13340-018-0370-2

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  • DOI: https://doi.org/10.1007/s13340-018-0370-2

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