Management of Steroid-Associated Hyperglycemia in Inpatient and Outpatient Settings
11:40 a.m. CT Saturday, June 13
Glucocorticoids (steroids) are used to treat a variety of medical conditions, but often cause unintended adverse effects such as steroid-associated hyperglycemia in susceptible individuals. It is estimated that approximately 10% of hospitalized patients received steroids. Furthermore, steroid-associated hyperglycemia can occur from systemic (oral or IV), topical, inhaled, or locally-injected forms of glucocorticoids. Approximately 22% of patients receiving steroids have a duration of therapy of more than six months. Unfortunately, there are few controlled trials of management with only a small number of patients, particularly in the outpatient setting, so the optimal strategy and dosing method have yet to be defined. The insulin regimens studied in randomized controlled trials utilize a basal analog or NPH with bolus insulin, NPH or rapid-acting correction insulin added to an existing regimen, or basal-bolus insulin versus basal-bolus with add-on NPH. These data generally support add-on NPH as an effective strategy, but data to support specific dosing methods are sparse, and data for non-insulin therapies are extremely limited. This session provides a brief overview and reviews most of the published randomized trials. Recommendations from a group of experts and guidelines released by the Joint British Diabetes Societies for Inpatient Care are reviewed briefly.
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