Clinical determinants of insulin requirements during treatment of prednisolone-induced hyperglycaemia

Angela X Chen; Anjana Radhakutty; Anthony Zimmermann; Stephen N Stranks; Campbell H Thompson; Morton G Burt

doi:10.1016/j.diabres.2023.110557

Clinical determinants of insulin requirements during treatment of prednisolone-induced hyperglycaemia

Diabetes Res Clin Pract. 2023 Mar:197:110557. doi: 10.1016/j.diabres.2023.110557. Epub 2023 Feb 1.

Authors

Angela X Chen¹, Anjana Radhakutty², Anthony Zimmermann³, Stephen N Stranks⁴, Campbell H Thompson⁵, Morton G Burt⁶

Affiliations

¹ Department of Endocrinology, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, Australia. Electronic address: angelaxun-nan.chen@sa.gov.au.
² College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Department of Medicine, Lyell McEwin Hospital, Elizabeth Vale, Australia. Electronic address: anjana.radhakutty@sa.gov.au.
³ Department of Medicine, Lyell McEwin Hospital, Elizabeth Vale, Australia; Faculty of Medicine and Health Sciences, University of Adelaide, Adelaide, Australia. Electronic address: anthony.zimmermann@sa.gov.au.
⁴ Department of Endocrinology, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, Australia. Electronic address: steve.stranks@sa.gov.au.
⁵ Faculty of Medicine and Health Sciences, University of Adelaide, Adelaide, Australia; Department of Medicine, Royal Adelaide Hospital, Adelaide, Australia. Electronic address: campbell.thompson@sa.gov.au.
⁶ Department of Endocrinology, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, Australia. Electronic address: Morton.burt@sa.gov.au.

PMID: 36736733
DOI: 10.1016/j.diabres.2023.110557

Abstract

Aims: The optimal treatment of prednisolone-associated hyperglycaemia is unclear, but guidelines recommend using a body weight-based daily insulin dose. This study evaluated how clinical variables were associated with insulin requirements in hospitalised patients with prednisolone-associated hyperglycaemia.

Methods: In this prospective study, fifty adult inpatients who were taking prednisolone ≥20 mg/day and experienced hyperglycaemia were prescribed a 24-h intravenous insulin infusion. The daily insulin dose required to attain a mean glucose of 8 mmol/L was calculated. The associations between daily insulin dose and clinical variables were assessed.

Results: The participants age was 69 ± 10 years, daily prednisolone dose was 34 ± 10 mg, HbA1c was 7.7 ± 2.0 % (61 ± 10 mmol/mol), 77 % had known type 2 diabetes and 30 % were female. In univariate analysis, weight was associated with daily insulin dose (r² = 0.11, p = 0.024). A multivariate model comprising sex, HbA1c, a prior diagnosis of diabetes, diabetes treatment and weight explained nearly-two thirds of the variability in daily insulin dose (r² = 0.65, p < 0.001).

Conclusions: In patients with prednisolone-associated hyperglycaemia, calculating insulin doses based on sex, HbA1c, diabetes status and regular diabetes treatment and weight may improve glycaemic control compared to weight-based dosing.

Keywords: Diabetes; Glucocorticoids; Hyperglycaemia; Insulin therapy; Prednisolone.

MeSH terms

Adult
Aged
Blood Glucose
Diabetes Mellitus, Type 2* / drug therapy
Female
Glycated Hemoglobin
Humans
Hyperglycemia* / chemically induced
Hyperglycemia* / drug therapy
Hypoglycemic Agents / adverse effects
Insulin / adverse effects
Insulin, Regular, Human / therapeutic use
Male
Middle Aged
Prednisolone / adverse effects
Prospective Studies

Substances

Insulin
Prednisolone
Hypoglycemic Agents
Glycated Hemoglobin
Insulin, Regular, Human
Blood Glucose