Hyperglycemia in hospitalized patients receiving corticosteroid premedication before the administration of radiologic contrast medium

Abstract

Rationale and objectives: To assess the effect of short-term corticosteroid premedication on serum glucose in hospitalized patients.

Materials and methods: Serum glucose in adult inpatients receiving corticosteroid premedication before a radiology study was compared to serum glucose in nonpremedicated controls between May 1, 2008, and September 12, 2009. Patients were categorized by type of nonionic contrast medium (intravenous [IV] or none) and route of corticosteroid premedication (oral, IV, none). Diabetes mellitus (types I and II) was evaluated as an independent risk factor. Patients without glucose estimations before and after premedication were excluded. Results were analyzed with analysis of variance and a stepwise linear regression analysis.

Results: There were 390 corticosteroid premedication episodes in 390 patients; 873 examinations in 844 patients served as controls. Cohorts receiving corticosteroid premedication experienced a brief (24-48 hour) increase in mean maximum postbaseline serum glucose (IV, +81 mg/dL; oral, +70 mg/dL) that was greater than the increase in nonpremedicated controls (+46 mg/dL). Type I (+144 mg/dL) and type II (+108 mg/dL) diabetics had a greater elevation than nondiabetics (+34 mg/dL). Both corticosteroid premedication (IV, P = .02; oral, P = .01) and diabetes mellitus (type I, P = .0002; type II, P < .0001) were significant independent risk factors of hyperglycemia. The use of nonionic intravascular contrast medium was not (P = .7). There was no significant difference between IV and oral premedication (P = .6), or type I and type II diabetes mellitus (P = .8).

Conclusions: Diabetes mellitus (type I and type II) and corticosteroid premedication (oral and IV) are significant independent risk factors for the development of brief hyperglycemia near the time of inpatient radiology studies.