Prevalence and Predictors of Corticosteroid-Related Hyperglycemia in Hospitalized Patients

doi:10.4158/EP.12.4.358

Endocrine Practice

Volume 12, Issue 4, July–August 2006, Pages 358-362

https://doi.org/10.4158/EP.12.4.358 Get rights and content

ABSTRACT

Objective

To investigate the prevalence of and risk factors for hyperglycemia in hospitalized patients receiving corticosteroids, which have been identified as an independent predictor of hyperglycemia.

Methods

We conducted a retrospective review of electronic medical records of patients admitted to the general medicine service at a university hospital during a 1-month period. Pharmacy charges were used to identify patients receiving high doses (≥ 40 mg/day of prednisone or the equivalent) of corticosteroids for at least 2 days. Occurrence of hyperglycemia and the presence of risk factors, including history of diabetes, duration of corticosteroid therapy, concurrent parenteral nutrition, antibiotic therapy, use of medications associated with hyperglycemia, severity of illness scores, and hospital length of stay, were determined. Patients experiencing multiple episodes of hyperglycemia (glucose levels ≥ 200 mg/dL) were compared with those who had ≤ 1 hyperglycemic episode. Patients without a history of diabetes were assessed separately.

Results

During the 1-month study period, 66 of 617 patients received high doses of corticosteroids, but only 50 of the 66 had glucose measurements. Hyperglycemia was documented in 32 of these 50 patients (64%), and multiple hyperglycemic episodes occurred in 26 (52%). A history of diabetes was documented in 12 of 26 patients who experienced multiple episodes, in comparison with 4 of 24 patients with ≤ 1 episode of hyperglycemia (P = 0.035). Among patients without a history of diabetes, 19 of 34 (56%) had hyperglycemia at least once. Patients with multiple episodes of hyperglycemia had more comorbid diseases, longer duration of corticosteroid therapy, and longer duration of hospital stay.

Conclusion

Hyperglycemia occurs in a majority of hospitalized patients receiving high doses of cortico-steroids. In light of the poor outcomes associated with hyperglycemia, protocols targeting its detection and management should be available for patients who receive corticosteroid therapy. (Endocr Pract. 2006;12:358-362)

Section snippets

INTRODUCTION

Hyperglycemia is one of the many known side effects of corticosteroid therapy, particularly when these drugs are administered in high doses (1., 2., 3., 4.). Observational studies have reported a prevalence of new-onset diabetes as high as 46% after initiation of corticosteroid therapy (2). New-onset diabetes was reported to occur in 10% to 20% of organ transplant recipients within a few years after corticosteroid therapy was instituted (3). In addition, corticosteroid use was found to be an

Study Design and Patient Population

A retrospective review was conducted of electronic medical records of patients admitted to the general medicine service at the University of Pittsburgh Medical Center between June 1, 2003, and June 30, 2003. All patients having pharmacy charge codes for intravenous or oral corticosteroid therapy were identified by using the hospital’s clinical and financial data repository, the Medical Archival Retrieval System (11). Patients receiving high-dose corticosteroid therapy, defined as ≥ 40 mg of

All Patients

Of 617 admissions during the 1-month study period, 66 patients (11%) were identified as having received high-dose corticosteroids for at least 2 days. Measurements of BG were not obtained in 16 of the 66 patients after initiation of corticosteroid therapy. In fact, 6 of these patients did not have a single BG determination during their entire hospitalization. Of the 50 patients with available BG values, 9 (18%) had one measurement and 41 (82%) had multiple determinations of BG. In these 50

DISCUSSION

To our knowledge, this is the first report of the prevalence of hyperglycemia related to corticosteroid therapy among hospitalized patients on a general medicine service. The results of this study indicate that more than half of the patients without known diabetes and 64% of all patients who received high-dose corticosteroid therapy experienced hyperglycemia. This finding is similar to the incidence of corticosteroid-related hyperglycemia reported on the neurology ward of a teaching hospital

CONCLUSION

Most patients receiving high-dose corticosteroid therapy experience hyperglycemic episodes. Patients who have a history of diabetes, prior corticosteroid use, multiple comorbidities, or a long duration of corticosteroid therapy are at higher risk for developing hyperglycemia. Despite this knowledge of risk factors, it is difficult to identify specifically who will have hyperglycemia. Our findings support the initiation of bedside BG monitoring in all patients prescribed high-dose glucocorticoid

FINANCIAL DISCLOSURE

During the past 5 years, Dr. Mary Korytkowski has received the following from pharmaceutical companies that make insulin: (1) consulting fees from Eli Lilly, (2) consulting fees and honoraria for speaking from Novo Nordisk, (3) honoraria for speaking engagements from Aventis, and (4) grant support from Aventis. There are no other competing interests to declare.

ACKNOWLEDGMENT

We thank Teresa McKaveney for assistance with preparation of our manuscript. Part of this material was presented as a poster at the American Diabetes Association 65th Annual Scientific Sessions, San Diego, CA, on June 12, 2005.

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Original ArticlePrevalence and Predictors of Corticosteroid-Related Hyperglycemia in Hospitalized Patients

ABSTRACT

Objective

Methods

Results

Conclusion

Section snippets

INTRODUCTION

Study Design and Patient Population

All Patients

DISCUSSION

CONCLUSION

FINANCIAL DISCLOSURE

ACKNOWLEDGMENT

Rheum Dis Clin North Am.

J Am Coll Cardiol.

J Clin Epidemiol.

Is enough attention being given to the adverse effects of corticosteroid therapy?

J Clin Pharm Ther.

Managing diabetes during glucocorticoid therapy: how to avoid metabolic emergencies

Postgrad Med

Glucocorticoids and the risk for initiation of hypoglycemic therapy

Arch Intern Med.

Risk factors for poor glycemic control in a medical intensive care unit (ICU) [abstract]

Diabetes.

Original Article
Prevalence and Predictors of Corticosteroid-Related Hyperglycemia in Hospitalized Patients