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Efficacy of a basal bolus insulin protocol to treat prednisolone-induced hyperglycaemia in hospitalised patients.
- Source :
-
Internal medicine journal [Intern Med J] 2015 Mar; Vol. 45 (3), pp. 261-6. - Publication Year :
- 2015
-
Abstract
- Background/aim: Few studies have specifically investigated treatment of prednisolone-induced hyperglycaemia.<br />Aim: To determine if a basal bolus insulin (BBI) protocol for inpatient hyperglycaemia is effective in patients prescribed acute prednisolone for an inflammatory disease.<br />Methods: In a cross-sectional study, 66 patients with type 2 diabetes admitted to a general medical ward and treated with BBI for up to 5 days were studied. Twenty-four patients were taking prednisolone ≥10 mg/day to treat an acute inflammatory disease. The remaining 42 patients were a control group. The primary outcome was mean daily blood glucose level.<br />Results: There were no significant differences in glycosylated haemoglobin (8.1 ± 1.0 vs 8.1 ± 1.6%, P = 0.88), age (77 ± 11 vs 75 ± 14 years, P = 0.57), male sex (63 vs 60%, P = 0.81) or body mass index (30.0 ± 5.3 vs 30.2 ± 11.5 kg/m(2) , P = 0.90) between patients taking prednisolone and controls. Mean daily glucose concentration was higher in patients taking prednisolone than in controls (12.2 ± 0.3 vs 10.0 ± 0.1 mmol/L, P < 0.001). Blood glucose level was higher in patients on prednisolone at 1700 h (14.6 ± 0.6 vs 10.3 ± 0.3 mmol/L, P < 0.001) and 2100 h (14.5 ± 0.6 vs 10.5 ± 0.3 mmol/L, P < 0.001), with no significant differences at 0700 h and 1200 h. These findings occurred despite patients taking prednisolone receiving a higher daily insulin dose than controls (0.67-0.70 vs 0.61-0.65 U/kg, P = 0.001) because of higher doses of ultra-rapid-acting insulin at 1200 h and 1700 h.<br />Conclusions: Hospitalised patients taking prednisolone had substantial afternoon and evening hyperglycaemia despite receiving BBI via a protocol for inpatient hyperglycaemia. Specific insulin regimens for prednisolone-induced hyperglycaemia are needed that recommend more insulin during this time period.<br /> (© 2015 Royal Australasian College of Physicians.)
- Subjects :
- Aged
Aged, 80 and over
Blood Glucose drug effects
Blood Glucose metabolism
Cross-Sectional Studies
Diabetes Mellitus, Type 2 blood
Diabetes Mellitus, Type 2 drug therapy
Female
Glucocorticoids adverse effects
Humans
Hyperglycemia blood
Hypoglycemic Agents administration & dosage
Male
Middle Aged
Treatment Outcome
Hospitalization
Hyperglycemia chemically induced
Hyperglycemia drug therapy
Insulin administration & dosage
Prednisolone adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1445-5994
- Volume :
- 45
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Internal medicine journal
- Publication Type :
- Academic Journal
- Accession number :
- 25565560
- Full Text :
- https://doi.org/10.1111/imj.12680