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Orešković D, Madero Pohlen A, Cvitković I, Alen JF, Raguž M, Álvarez-Sala de la Cuadra A, Bazarra Castro GJ, Bušić Z, Konstantinović I, Ledenko V, Martínez Macho C, Müller D, Žarak M, Jovanov-Milosevic N, Chudy D, Marinović T. Chronic hyperglycemia and intracranial meningiomas. BMC Cancer 2024; 24:488. [PMID: 38632533 PMCID: PMC11022447 DOI: 10.1186/s12885-024-12243-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
Meningiomas are among the most common primary tumors of the central nervous system. Previous research into the meningioma histological appearance, genetic markers, transcriptome and epigenetic landscape has revealed that benign meningiomas significantly differ in their glucose metabolism compared to aggressive lesions. However, a correlation between the systemic glucose metabolism and the metabolism of the tumor hasn't yet been found. We hypothesized that chronic levels of glycaemia (approximated with glycated hemoglobin (HbA1c)) are different in patients with aggressive and benign meningiomas. The study encompassed 71 patients with de novo intracranial meningiomas, operated on in three European hospitals, two in Croatia and one in Spain. Our results show that patients with WHO grade 2 meningiomas had significantly higher HbA1c values compared to patients with grade 1 lesions (P = 0.0290). We also found a significant number of patients (19/71; 26.7%) being hyperglycemic, harboring all the risks that such a condition entails. Finally, we found a significant correlation between our patients' age and their preoperative HbA1c levels (P = 0.0008, ρ(rho) = 0.388), suggesting that older meningioma patients are at a higher risk of having their glycaemia severely dysregulated. These findings are especially important considering the current routine and wide-spread use of corticosteroids as anti-edematous treatment. Further research in this area could lead to better understanding of meningiomas and have immediate clinical impact.
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Affiliation(s)
- D Orešković
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia.
| | - A Madero Pohlen
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - I Cvitković
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - J F Alen
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - M Raguž
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - G J Bazarra Castro
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - Z Bušić
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - I Konstantinović
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - V Ledenko
- Department of Neurosurgery, University Hospital Center Split, Split, Croatia
| | - C Martínez Macho
- Department of Neurosurgery, University Hospital de la Princesa, Madrid, Spain
| | - D Müller
- Department of Pathology, Clinical Hospital Dubrava, Zagreb, Croatia
| | - M Žarak
- Clinical Department of Laboratory Diagnostics, Clinical Hospital Dubrava, Zagreb, Croatia
- Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - N Jovanov-Milosevic
- Department of Biology, School of Medicine, University of Zagreb, Zagreb, Croatia
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, School of Medicine, Croatian Institute for Brain Research, University of Zagreb, Zagreb, Croatia
| | - D Chudy
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
- Scientific Centre of Excellence for Basic, Clinical and Translational Neuroscience, School of Medicine, Croatian Institute for Brain Research, University of Zagreb, Zagreb, Croatia
| | - T Marinović
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
- Department of Neurology and Neurosurgery, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Martin-Grace J, Tomkins M, O'Reilly MW, Sherlock M. Iatrogenic adrenal insufficiency in adults. Nat Rev Endocrinol 2024; 20:209-227. [PMID: 38272995 DOI: 10.1038/s41574-023-00929-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 01/27/2024]
Abstract
Iatrogenic adrenal insufficiency (IAI) is the most common form of adrenal insufficiency in adult patients, although its overall exact prevalence remains unclear. IAI is associated with adverse clinical outcomes, including adrenal crisis, impaired quality of life and increased mortality; therefore, it is imperative that clinicians maintain a high index of suspicion in patients at risk of IAI to facilitate timely diagnosis and appropriate management. Herein, we review the major causes, clinical consequences, diagnosis and care of patients with IAI. The management of IAI, particularly glucocorticoid-induced (or tertiary) adrenal insufficiency, can be particularly challenging, and the provision of adequate glucocorticoid replacement must be balanced against minimizing the cardiometabolic effects of excess glucocorticoid exposure and optimizing recovery of the hypothalamic-pituitary-adrenal axis. We review current treatment strategies and their limitations and discuss developments in optimizing treatment of IAI. This comprehensive Review aims to aid clinicians in identifying who is at risk of IAI, how to approach screening of at-risk populations and how to treat patients with IAI, with a focus on emergency management and prevention of an adrenal crisis.
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Affiliation(s)
- Julie Martin-Grace
- Department of Endocrinology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Maria Tomkins
- Department of Endocrinology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Michael W O'Reilly
- Department of Endocrinology, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland
| | - Mark Sherlock
- Department of Endocrinology, Royal College of Surgeons in Ireland, Dublin, Ireland.
- Department of Endocrinology, Beaumont Hospital, Dublin, Ireland.
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Cho JH, Suh S. Glucocorticoid-Induced Hyperglycemia: A Neglected Problem. Endocrinol Metab (Seoul) 2024; 39:222-238. [PMID: 38532282 PMCID: PMC11066448 DOI: 10.3803/enm.2024.1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/28/2024] Open
Abstract
Glucocorticoids provide a potent therapeutic response and are widely used to treat a variety of diseases, including coronavirus disease 2019 (COVID-19) infection. However, the issue of glucocorticoid-induced hyperglycemia (GIH), which is observed in over one-third of patients treated with glucocorticoids, is often neglected. To improve the clinical course and prognosis of diseases that necessitate glucocorticoid therapy, proper management of GIH is essential. The key pathophysiology of GIH includes systemic insulin resistance, which exacerbates hepatic steatosis and visceral obesity, as well as proteolysis and lipolysis of muscle and adipose tissue, coupled with β-cell dysfunction. For patients on glucocorticoid therapy, risk stratification should be conducted through a detailed baseline evaluation, and frequent glucose monitoring is recommended to detect the onset of GIH, particularly in high-risk individuals. Patients with confirmed GIH who require treatment should follow an insulin-centered regimen that varies depending on whether they are inpatients or outpatients, as well as the type and dosage of glucocorticoid used. The ideal strategy to maintain normoglycemia while preventing hypoglycemia is to combine basal-bolus insulin and correction doses with a continuous glucose monitoring system. This review focuses on the current understanding and latest evidence concerning GIH, incorporating insights gained from the COVID-19 pandemic.
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Affiliation(s)
- Jung-Hwan Cho
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sunghwan Suh
- Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Ketaroonrut N, Kiertiburanakul S, Sriphrapradang C. Optimal initial insulin dosage for managing steroid-induced hyperglycemia in hospitalized COVID-19 patients: A retrospective single-center study. SAGE Open Med 2024; 12:20503121241238148. [PMID: 38516643 PMCID: PMC10956164 DOI: 10.1177/20503121241238148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/22/2024] [Indexed: 03/23/2024] Open
Abstract
Objectives To determine the optimal initial insulin dosage for controlling hyperglycemia in COVID-19 patients receiving steroids, an area with limited data. Methods We retrospectively analyzed 156 COVID-19 patients with steroid-induced hyperglycemia treated with insulin. Patients were categorized by their total daily dose of subcutaneous insulin therapy when starting dexamethasone ⩾6 mg/day or equivalent dose of glucocorticoid: Group A (⩽0.29 units/kg), Group B (0.3-0.49 units/kg), Group C (0.5-0.69 units/kg), and Group B (⩾0.7 units/kg). Treatment failure was defined as mean blood glucose level > 280 mg/dL for two consecutive days after initiating insulin or any blood glucose ⩾ 400 mg/dL. Results The mean age was 64 ± 14 years, with 50% male, and a mean body mass index of 26.9 ± 6.9 kg/m2. Most had preexisting type 2 diabetes (62%). Mean admission blood glucose and HbA1c were 233 ± 112 mg/dL and 7.8 ± 2.3%, respectively. Group A had the lowest HbA1c (6.7 ± 1.2%), while group D had the highest (9.8 ± 2.5%). Median daily dexamethasone dosage or equivalent was 36 (IQR 16.72) mg, with no significant differences in among groups. Group A had the lowest treatment failure rate. There were no significant differences in treatment failure rate between Groups B, C, and D. Additionally, there were no statistically significant differences in mean BG across the groups: Group A 232 ± 42 mg/dL, Group B 247 ± 57 mg/dL, Group C 247 ± 61 mg/dL, and Group D 227 ± 67 mg/dL (p = 0.2). Group D had a significantly higher rate of level 1 hypoglycemia (p = 0.008), while no differences in clinically significant hypoglycemia (level 2 or 3) were observed between groups. Conclusions Among patients requiring TDD ⩾ 0.3 units/kg/day, there was no significant difference in treatment failure rate between Groups B, C, and D. Group D had the highest rate of level 1 hypoglycemia. This initial insulin dosage for hospitalized COVID-19 patients on high-dose steroid therapy should be personalized.
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Affiliation(s)
- Nuttavadee Ketaroonrut
- Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasisopin Kiertiburanakul
- Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chutintorn Sriphrapradang
- Faculty of Medicine, Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Stepanian L, Laughlin RS, Bacher C, Izenberg A, Hodgkinson V, Dyck A, Breiner A, Kassardjian CD. Chronic glucocorticoid management in neuromuscular disease: A survey of neuromuscular neurologists. Muscle Nerve 2024. [PMID: 38411028 DOI: 10.1002/mus.28069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
INTRODUCTION/AIMS Glucocorticoids (GC) are first-line therapy for many neuromuscular diseases. There is a lack of guidelines regarding the prevention and management of GC complications in the context of neuromuscular disease, introducing the potential for practice variation, that may compromise quality of care. Our aim was to evaluate the practice patterns among Canadian adult neuromuscular neurologists on the screening, management, and treatment of GC-related complications and to identify variances in practice. METHODS A web-based anonymous questionnaire was disseminated to 99 Canadian adult neuromuscular neurologists. Questions addressed patterns of screening, prevention, monitoring, and treatment of GC-induced adverse events, including infection prophylaxis, vaccination, bone health, hyperglycemia, and other complications. RESULTS Seventy-one percent completed the survey. Of those, 52% perform screening blood work prior to initiating GC, 56% screen for infections, and 18% for osteoporosis. The majority monitor glycemic control and blood pressure (>85%). Thirty-two (46%) reported that they do not primarily monitor GC complications, but rather provide recommendations to the primary care physician. Pneumocystis jiroveci pneumonia prophylaxis was never used by 29%, and 29% recommend vaccinations prior to GC initiation. Calcium supplementation was recommended by 80% to prevent osteoporosis. Only 36% were aware of any existing guidelines for preventing GC complications, and 91% endorsed a need for neurology-specific guidelines. DISCUSSION There is substantial variability in the management of GC adverse effects among neuromuscular neurologists, often not corresponding to limited published literature. Our results support the need for improved education and neurology-specific guidelines to help standardize practice and improve and prevent complications.
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Affiliation(s)
- Lora Stepanian
- School of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Corey Bacher
- Division of Neurology, Department of Medicine, Scarborough Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Aaron Izenberg
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada
| | - Victoria Hodgkinson
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Adrienna Dyck
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Ari Breiner
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Charles D Kassardjian
- Division of Neurology, Department of Medicine, Unity Health Toronto and University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
- Neurology Quality and Innovation Lab, Toronto, Ontario, Canada
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Monteiro Lopes S, Maia A, Melo P, Abreu S, Paiva I, Barros L. [Non-Insulin Antidiabetic Agents in the Management of Hyperglycaemia of Non-Critical Hospitalized Patients]. ACTA MEDICA PORT 2024; 37:207-214. [PMID: 38316163 DOI: 10.20344/amp.20858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
Hyperglycaemia affects more than 30% of adults hospitalized for non-critical illness and is associated with an increased risk of adverse clinical outcomes. Insulin therapy is widely used for its safety and efficacy. However, given the growing availability of new drugs and new classes of antidiabetic agents with benefits beyond glycaemic control, challenges arise regarding their use in the hospital setting. This article aims to review and summarize the most recently available evidence and recommendations on the role of non-insulin antidiabetic agents in the management of hyperglycaemia in hospitalized patients. Insulin therapy remains the method of choice. Dipeptidyl peptidase 4 inhibitors can be considered in mild to moderate hyperglycaemia. Glucagon-like peptide 1 receptor agonists have recently shown promising results, with high efficacy in glycaemic control and low risk of hypoglycaemia. There are concerns regarding the increased risk of acidosis with metformin use, especially in cases of acute illness, although there is no evidence to support its suspension in selected patients with relative clinical stability. Sodium-glucose cotransporter-2 inhibitors should be discontinued in clinical situations that may predispose to ketoacidosis, including episodes of acute illness. The hospital use of sulfonylureas and thiazolidinediones is not advised.
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Affiliation(s)
- Sofia Monteiro Lopes
- Grupo de Estudos de Diabetes. Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. Lisboa; Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Ariana Maia
- Grupo de Estudos de Diabetes. Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. Lisboa; Serviço de Endocrinologia. Centro Hospitalar Universitário do Porto. Porto. Portugal
| | - Pedro Melo
- Grupo de Estudos de Diabetes. Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. Lisboa; Serviço de Endocrinologia. Unidade Local de Saúde de Matosinhos. Portugal
| | - Silvestre Abreu
- Grupo de Estudos de Diabetes. Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. Lisboa; Serviço Regional de Saúde da Região Autónoma da Madeira. Funchal. Portugal
| | - Isabel Paiva
- Grupo de Estudos de Diabetes. Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. Lisboa; Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Luísa Barros
- Grupo de Estudos de Diabetes. Sociedade Portuguesa de Endocrinologia, Diabetes e Metabolismo. Lisboa; Serviço de Endocrinologia, Diabetes e Metabolismo. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Limbachia V, Nunney I, Page DJ, Barton HA, Patel LK, Thomason GN, Green SL, Lewis KFJ, Dhatariya K. The effect of different types of oral or intravenous corticosteroids on capillary blood glucose levels in hospitalized inpatients with and without diabetes. Clin Ther 2024; 46:e59-e63. [PMID: 38061932 DOI: 10.1016/j.clinthera.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 11/06/2023] [Accepted: 11/16/2023] [Indexed: 02/27/2024]
Abstract
PURPOSE This study investigated: (1) the type of corticosteroid associated with the greatest degree of hyperglycemia, assessed using bedside capillary blood glucose monitoring, in hospitalized patients; and (2) the pattern of hyperglycemia throughout the day with the use of each type of corticosteroid. METHODS This single-center, retrospective study used data from 964 adult inpatients receiving oral or IV corticosteroids. Data on capillary blood glucose concentrations and time taken over 7 days were collected. A mixed model for repeated measures was applied to investigate changes in glucose concentration over time with the use of four different corticosteroids. An autoregressive covariance structure was used to model correlations between repeated measurements. FINDINGS Across all 7 days, the mean blood glucose concentration was greater with dexamethasone compared to that with hydrocortisone (mean difference, 16.6 mg/dL [95% CI, 8.1-24.8] [0.92 mmol/L (95% CI, 0.45-1.38)]) or prednisolone (mean difference, 20.0 mg/dL [95% CI, 14.2-25.7] [1.11 mmol/L (95% CI, 0.79-1.43)]). The mean blood glucose concentration was greater with methylprednisolone compared to that with hydrocortisone (mean difference, 23.9 mg/dL [95% CI, 11.3-36.4] [1.33 mmol/L (95% CI, 0.63-2.02)]), and with methylprednisolone versus prednisolone (mean difference, 27.4 mg/dL [95% CI, 16.4-38.3] [1.52 mmol/L (95% CI, 0.91-2.13)]). There were no significant differences in the patterns of hyperglycemia at six time points of the day with each type of corticosteroid. IMPLICATIONS Treatment with oral or IV dexamethasone or methylprednisolone was associated with greater hyperglycemia in comparison to prednisolone and hydrocortisone. More vigorous monitoring and intervention, when necessary, are suggested in adult inpatients receiving corticosteroids, in particular dexamethasone and methylprednisolone.
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Affiliation(s)
- Vaishali Limbachia
- Department of Medicine, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Ian Nunney
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Daniel J Page
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Hannah A Barton
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Leena K Patel
- Department of Medicine, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, United Kingdom
| | - Georgia N Thomason
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Stephan L Green
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Kieran F J Lewis
- Department of Medicine, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, United Kingdom
| | - Ketan Dhatariya
- Department of Medicine, Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Elsie Bertram Diabetes Centre-Norfolk and Norwich University Hospitals National Health Service Foundation Trust, Norwich, United Kingdom.
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Sarriyah JF, Alghamdi AS, Al-Otaibi NM, Abdulrahman BB, Aljaed KM. Prevalence of Steroid-Induced Hyperglycemia in King Abdulaziz Specialist Hospital, Taif City, Saudi Arabia. Cureus 2024; 16:e54430. [PMID: 38510914 PMCID: PMC10951554 DOI: 10.7759/cureus.54430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
Background Hyperglycemia is a common side effect of high-dose steroid therapy in hospitalized patients. Objectives To assess the prevalence of hyperglycemia among hospitalized patients receiving steroid therapy. Methods A retrospective study was conducted among 245 patients. The inclusion criteria were patients undergoing steroid therapy and admitted to a single tertiary care hospital due to medical complications or exacerbation of the diseases they were suffering from. Data encompassing patient demographics, admission, discharge dates, comorbidities, medication histories, laboratory results (including blood glucose levels), and documented corticosteroid administrations were meticulously gathered from electronic health records (EHRs). A logistic regression model analysis was done to predict the risk factors of poor glycemic control among hospitalized patients. Results The prevalence of hyperglycemia among the patients who were on steroid therapy was 34.2%. About 70.7% of the patients who required insulin at the time of admission required >17 units, and the insulin requirement was significantly higher among patients who received dexamethasone compared to other steroids (p<0.05). Older age (>65 years) was found to be independently associated with poor glycemic control (p<0.05). Conclusion The study revealed that almost one-third of patients on steroid therapy had hyperglycemia. Monitoring of patients for hyperglycemia after beginning high-dose steroid therapy should be done.
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Affiliation(s)
- Jehan F Sarriyah
- Internal Medicine, King Abdulaziz Specialist Hospital, Taif, SAU
| | - Adel S Alghamdi
- Endocrinology, King Abdulaziz Specialist Hospital, Taif, SAU
| | | | | | - Kholoud M Aljaed
- Internal Medicine, King Abdulaziz Specialist Hospital, Taif, SAU
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夏 娟, 杜 丽, 席 学, 徐 筑. [Current Status of Research on COVID-19 Patients With Concomitant Hyperglycemia and the Management Strategies of Hyperglycemia]. Sichuan Da Xue Xue Bao Yi Xue Ban 2024; 55:230-235. [PMID: 38322513 PMCID: PMC10839475 DOI: 10.12182/20240160602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Indexed: 02/08/2024]
Abstract
The global pandemic of coronavirus disease 2019 (COVID-19) poses a serious threat to human health, leading to a relatively high mortality in patients with severe or critical conditions in particular. Hyperglycemia is one of the high-risk factors for poor prognosis in these patients. Patients with COVID-19 are more likely to develop hyperglycemia, regardless of whether there is a previous history of diabetes mellitus. Glucocorticoid therapy is an important part of the anti-inflammatory regimen for COVID-19. However, the use of glucocorticoid significantly increases the occurrence of hyperglycemic events in COVID-19 patients, ultimately leading to poor prognosis. Timely monitoring of blood glucose and early intervention for hyperglycemia contribute to the improvement in the outcome of COVID-19 patients. In this paper, we comprehensively reviewed the potential mechanisms of COVID-19 and concomitant hyperglycemia. We reviewed the latest findings on the blood glucose management strategies for COVID-19 patients with concomitant hyperglycemia, aiming to optimize the management of hyperglycemia in COVID-19 patients and improve the outcome of the disease.
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Affiliation(s)
- 娟 夏
- 贵州医科大学附属医院 呼吸与危重症医学科 (贵阳 550004)Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - 丽娟 杜
- 贵州医科大学附属医院 呼吸与危重症医学科 (贵阳 550004)Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - 学莉 席
- 贵州医科大学附属医院 呼吸与危重症医学科 (贵阳 550004)Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
| | - 筑萍 徐
- 贵州医科大学附属医院 呼吸与危重症医学科 (贵阳 550004)Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, China
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Galindo RJ, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S295-S306. [PMID: 38078585 PMCID: PMC10725815 DOI: 10.2337/dc24-s016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Pofi R, Caratti G, Ray DW, Tomlinson JW. Treating the Side Effects of Exogenous Glucocorticoids; Can We Separate the Good From the Bad? Endocr Rev 2023; 44:975-1011. [PMID: 37253115 PMCID: PMC10638606 DOI: 10.1210/endrev/bnad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/25/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
It is estimated that 2% to 3% of the population are currently prescribed systemic or topical glucocorticoid treatment. The potent anti-inflammatory action of glucocorticoids to deliver therapeutic benefit is not in doubt. However, the side effects associated with their use, including central weight gain, hypertension, insulin resistance, type 2 diabetes (T2D), and osteoporosis, often collectively termed iatrogenic Cushing's syndrome, are associated with a significant health and economic burden. The precise cellular mechanisms underpinning the differential action of glucocorticoids to drive the desirable and undesirable effects are still not completely understood. Faced with the unmet clinical need to limit glucocorticoid-induced adverse effects alongside ensuring the preservation of anti-inflammatory actions, several strategies have been pursued. The coprescription of existing licensed drugs to treat incident adverse effects can be effective, but data examining the prevention of adverse effects are limited. Novel selective glucocorticoid receptor agonists and selective glucocorticoid receptor modulators have been designed that aim to specifically and selectively activate anti-inflammatory responses based upon their interaction with the glucocorticoid receptor. Several of these compounds are currently in clinical trials to evaluate their efficacy. More recently, strategies exploiting tissue-specific glucocorticoid metabolism through the isoforms of 11β-hydroxysteroid dehydrogenase has shown early potential, although data from clinical trials are limited. The aim of any treatment is to maximize benefit while minimizing risk, and within this review we define the adverse effect profile associated with glucocorticoid use and evaluate current and developing strategies that aim to limit side effects but preserve desirable therapeutic efficacy.
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Affiliation(s)
- Riccardo Pofi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - Giorgio Caratti
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
| | - David W Ray
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Oxford Kavli Centre for Nanoscience Discovery, University of Oxford, Oxford OX37LE, UK
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford OX3 7LE, UK
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12
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Bridgewater S, Shepherd MA, Dawson J, Richards P, Silverthorne C, Ndosi M, Almeida C, Black RJ, Cheah JTL, Dures E, Ghosh N, Hoon EA, Lyne S, Navarro-Millan I, Pearce-Fisher D, Ruediger C, Tieu J, Yip K, Mackie SL, Goodman S, Hill C, Robson JC. Measuring the impact of steroid therapy on health-related quality of life in patients with rheumatic diseases: international development of a glucocorticoid treatment-specific patient-reported outcome measure. Rheumatology (Oxford) 2023; 62:3565-3575. [PMID: 36840642 PMCID: PMC10629780 DOI: 10.1093/rheumatology/kead081] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVES Glucocorticoids (GCs) ('steroids') are used to treat rheumatic diseases but adverse effects are common. We aimed to explore the impact of GC therapy on health-related quality of life (HRQoL), to inform the development of a treatment-specific patient-reported outcome measure (PROM) for use in clinical trials and practice. METHODS Semi-structured qualitative interviews were conducted with patients from the UK, USA and Australia, treated for a rheumatic condition with GCs in the last 2 years. Purposive sampling was used to select participants with a range of demographic and disease features. An initial conceptual framework informed interview prompts and cues. Interviews elicited GC-related physical and psychological symptoms and salient aspects of HRQoL in relation to GC therapy. Interview data were analysed inductively to develop initial individual themes and domains. Candidate questionnaire items were developed and refined. RESULTS Sixty semi-structured qualitative interviews were conducted (UK n = 34, USA n = 10, Australia n = 16). The mean age was 58 years; 39/60 were female; and 18 rheumatic diseases were represented. Some 126 individual themes were identified and organized into six domains: physical symptoms; psychological symptoms; psychological impact of steroids; impact of steroids on participation; impact of steroids on relationships; and benefits of steroids. Candidate questionnaire items were tested and refined by piloting with patient research partners, iterative rounds of cognitive interviews and linguistic translatability assessment, informing a draft questionnaire. CONCLUSION We describe an international qualitative study to develop candidate items for a treatment-specific PROM for patients with rheumatic diseases. A future survey will enable the validation of a final version of the PROM.
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Affiliation(s)
- Susan Bridgewater
- Faculty of Health and Applied Sciences, School of Health and Social Wellbeing, University of the West of England—UWE Bristol, Bristol, UK
- Academic Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Michael A Shepherd
- Faculty of Health and Applied Sciences, School of Health and Social Wellbeing, University of the West of England—UWE Bristol, Bristol, UK
- Academic Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jill Dawson
- Department of Population Health (HSRU), University of Oxford, Oxford, UK
| | - Pamela Richards
- Academic Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Christine Silverthorne
- Faculty of Health and Applied Sciences, School of Health and Social Wellbeing, University of the West of England—UWE Bristol, Bristol, UK
- Academic Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Mwidimi Ndosi
- Faculty of Health and Applied Sciences, School of Health and Social Wellbeing, University of the West of England—UWE Bristol, Bristol, UK
- Academic Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Celia Almeida
- Faculty of Health and Applied Sciences, School of Health and Social Wellbeing, University of the West of England—UWE Bristol, Bristol, UK
- Academic Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rachel J Black
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- Rheumatology Department, Royal Adelaide Hospital, Adelaide, Australia
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Jonathan T L Cheah
- Department of Medicine, Division of Rheumatology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Emma Dures
- Faculty of Health and Applied Sciences, School of Health and Social Wellbeing, University of the West of England—UWE Bristol, Bristol, UK
- Academic Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Nilasha Ghosh
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Elizabeth A Hoon
- Discipline of General Practice, The University of Adelaide, Adelaide, Australia
- School of Public Health, The University of Adelaide, Adelaide, Australia
| | - Suellen Lyne
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Iris Navarro-Millan
- Department of Medicine, Division of Rheumatology, University of Massachusetts Medical School, Worcester, MA, USA
- Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Diyu Pearce-Fisher
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Carlee Ruediger
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Joanna Tieu
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, Australia
- Rheumatology Unit, Lyell McEwin Hospital, Adelaide, Australia
| | - Kevin Yip
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Susan Goodman
- Division of Rheumatology, Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Catherine Hill
- Discipline of Medicine, The University of Adelaide, Adelaide, Australia
- Rheumatology Department, Royal Adelaide Hospital, Adelaide, Australia
- Department of Rheumatology, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Joanna C Robson
- Faculty of Health and Applied Sciences, School of Health and Social Wellbeing, University of the West of England—UWE Bristol, Bristol, UK
- Academic Rheumatology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Das AK, Saboo B, Chawla R, Aravind SR, Rajput R, Singh AK, Mukherjee JJ, Jhingan A, Shah P, Deshmukh V, Kale S, Jaggi S, Sridhar GR, Dhediya R, Gaurav K. Time to reposition sulfonylureas in type 2 diabetes management in Indian context: A pragmatic practical approach. Int J Diabetes Dev Ctries 2023:1-19. [PMID: 37360324 PMCID: PMC10113130 DOI: 10.1007/s13410-023-01192-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 03/20/2023] [Indexed: 06/28/2023] Open
Abstract
Sulfonylureas (SU) continue to be a vital therapeutic category of oral hypoglycemic agents (OHAs) for the management of type 2 diabetes mellitus (T2DM). Physicians consider modern SU (gliclazide and glimepiride) as "safe and smart" choices for T2DM management. The presence of multiple international guidelines and scarcity of a national guideline may contribute to the challenges faced by few physicians in choosing the right therapeutic strategy. The role of SU in diabetes management is explicit, and the present consensus aims to emphasize the benefits and reposition SU in India. This pragmatic, practical approach aims to define expert recommendations for the physicians to improve caregivers' knowledge of the management of T2DM, leading to superior patient outcomes.
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Affiliation(s)
- Ashok Kumar Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Banshi Saboo
- Department of Diabetology, DIA-CARE, Ahmedabad, India
| | | | - S. R. Aravind
- Department of Medicine, Diacon Hospital, Bengaluru, India
| | - Rajesh Rajput
- Department of Endocrinology, PGIMS, Rohtak, Haryana India
| | | | - J. J. Mukherjee
- Department of Endocrinology and Diabetes, Apollo Gleneagles Hospital, Kolkata, India
| | - Ashok Jhingan
- Department of Diabetology, Delhi Diabetes Education and Research Foundation, New Delhi, India
| | - Parag Shah
- Department of Endocrinology and Diabetes, Gujarat Endocrine Centre, Ahmedabad, India
| | - Vaishali Deshmukh
- Department of Endocrinology, Deshmukh Clinic and Deenanath Mangeshkar Hospital and Research Centre, Pune, India
| | - Shailaja Kale
- Dr Shailaja Kale’s Diabetes & Speciality Clinic, Pune, India
| | | | | | - Rajnish Dhediya
- Department of Medical Affairs, Dr Reddy’s Laboratories Ltd, Hyderabad, Telangana India
| | - Kumar Gaurav
- Department of Medical Affairs, Dr Reddy’s Laboratories Ltd, Hyderabad, Telangana India
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14
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Kotwal A, Perlman JE, Goldner WS, Marr A, Mammen JS. Endocrine Dysfunction From Immune Checkpoint Inhibitors: Pearls and Pitfalls in Evaluation and Management. JCO Oncol Pract 2023:OP2300023. [PMID: 37023383 DOI: 10.1200/op.23.00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Immune checkpoint inhibitors (ICPis) have proven extremely efficacious in cancer therapy but also lead to a plethora of immune-related adverse events (irAEs). The endocrine irAEs are not only quite common but also may pose a challenge to the clinician while managing a patient with cancer treated with ICPis. The clinical features of endocrine dysfunction are usually nonspecific and may overlap with concurrent illnesses, underlying the importance of accurate hormone testing and efforts toward case-finding. The management of endocrine irAEs is unique in the focus being on hormone replacement rather than curtailing the autoimmune process. Although the management of thyroid irAEs appears straightforward, adrenal insufficiency and insulin-dependent diabetes can be life-threatening if not promptly recognized and treated. This clinical review synthesizes the studies to provide pearls and pitfalls in the evaluation and management of endocrine irAEs with specific reference to guidelines from oncologic societies.
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Affiliation(s)
- Anupam Kotwal
- Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Jordan E Perlman
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University Medical Center, Baltimore, MD
| | - Whitney S Goldner
- Division of Diabetes, Endocrinology, and Metabolism, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Alissa Marr
- Division of Oncology and Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Jennifer S Mammen
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Johns Hopkins University Medical Center, Baltimore, MD
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15
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Mulla K, Farag S, Moore B, Matharu S, Young K, Larkin J, Popat S, Morganstein DL. Hyperglycaemia following immune checkpoint inhibitor therapy-Incidence, aetiology and assessment. Diabet Med 2023; 40:e15053. [PMID: 36696014 DOI: 10.1111/dme.15053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/11/2022] [Accepted: 01/23/2023] [Indexed: 01/26/2023]
Abstract
AIMS We systematically studied the presence of hyperglycaemia during treatment with Immune Checkpoint Inhibitors (ICPI) for cancer, in those with and without diabetes at baseline, and determined the cause of new-onset hyperglycaemia, METHODS: Retrospective review of electronic records of those receiving an ICPI for melanoma, lung or renal cancer. RESULTS Overall, 959 participants were included. In this study, 103 had diabetes at baseline (10.7%). Those with lung cancer had the highest frequency of diabetes; 131 people had hyperglycaemia (defined as at least one glucose ≥11.1 mmol/L) in the year after starting an ICPI. The incidence was 55% in those with diabetes at baseline, and 8.6% in those without baseline diabetes. Among 74 with new-onset hyperglycaemia (without pre-existing diabetes) 76% was attributable to steroid induced diabetes, with 9.5% due to ICPI Induced diabetes resembling type 1 diabetes. CONCLUSIONS Hyperglycaemia is common in persons receiving an ICPI for cancer, including 8.6% of those without known diabetes. While much of this is due to glucocorticoid use, care is needed to avoid missing those with ICPI-induced diabetes who are at risk of diabetic ketoacidosis, which is a medical emergency.
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Affiliation(s)
- Kaenat Mulla
- Beta Cell Diabetes Unit, Chelsea and Westminster Hospital, London, UK
| | | | - Benedict Moore
- Beta Cell Diabetes Unit, Chelsea and Westminster Hospital, London, UK
| | | | - Kate Young
- Skin Unit, Royal Marsden Hospital, London, UK
| | | | | | - Daniel Laurence Morganstein
- Beta Cell Diabetes Unit, Chelsea and Westminster Hospital, London, UK
- Lung Unit, Royal Marsden Hospital, London, UK
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16
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Madan S, Shelly S, Yadav R, Rohatgi J, Bajaj I, Tadu N, Rahul S, Das GK, Sahu PK, Gupta N. A Study on the Impact of Diabetes Mellitus on the Severity of COVID-19-Associated Mucormycosis. Ann Natl Acad Med Sci 2023. [DOI: 10.1055/s-0042-1759890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Abstract
Objectives: Diabetes mellitus (DM) seems the most common predisposing factor for rhino-orbito-cerebral mucormycosis (ROCM). This study aimed to study the impact of DM on the severity of COVID-19-associated ROCM (CAM).
Methods: This was a retrospective analytical study performed over a period of 3 months to assess the impact of DM on the severity of CAM in 100 patients and association of clinical correlates of DM with severity of CAM.
Statistical analysis: The data collected using the study tools were converted into a computer-based spreadsheet and analyzed. The statistical analysis comprised a descriptive analysis that involved calculating means, standard deviations, and proportions. For calculating the significance of the difference of mean between two groups, Student's t-test was applied. In addition, chi-square test (or Fisher's t-test if applicable) was applied to study the significance of association of clinical correlates of DM with severity of CAM for categorical variables and t-test for continuous variables.
Results: The prevalence of DM was 67%. The average presenting blood sugar level was 245.9 ± 99.86 mg%. Glycated hemoglobin level between 4.5 and 6.5% was observed in 57 patients and over 6.5% in 43 subjects. A high body mass index (BMI) of 25 and above was noted in 52 patients. A significantly higher level of presenting blood sugar and a longer duration of hospital stay was noted in patients having stage 3b or higher (p < 0.05) when compared with those having stage 3a or below. No significant correlation was observed in patients in stage 3a or below and those presenting with stage 3b or higher in terms of BMI, waist to hip ratio, or total cholesterol levels. There was a strong correlation between blood sugar level at presentation, severity of DM with the severity of ROCM, and a strong inverse correlation noted between HDL level and severity of ROCM.
Conclusion: A poor metabolic control is associated with a higher risk of a severe disease with intracranial involvement.
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Affiliation(s)
- Siddharth Madan
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Shelly Shelly
- Department of Medicine, University College of Medical Sciences and Associated GTB Hospital, India
| | - Rekha Yadav
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Jolly Rohatgi
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Ishita Bajaj
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Nampi Tadu
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Sharma Rahul
- Department of Community Medicine, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Gopal Krushna Das
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Pramod Kumar Sahu
- Department of Ophthalmology, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
| | - Neelima Gupta
- Department of ENT, University College of Medical Sciences and Associated GTB Hospital, University of Delhi, Delhi, India
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Vaswani PPM, Bernardo DCC, Quero AKH, Cruz MCA, Bonifacio LB. The association of hyperglycemia with the development of infectious complications in adult Filipino patients with acute lymphoblastic leukemia. Hematol Transfus Cell Ther 2023; 45:66-71. [PMID: 34593366 DOI: 10.1016/j.htct.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 05/03/2021] [Accepted: 06/13/2021] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Hyperglycemia occurs in Acute Lymphoblastic Leukemia (ALL) due to chemotherapeutic agents and may be stress-induced. Given the potential impact of hyperglycemia on the clinical outcomes of ALL patients, we sought to determine the association of hyperglycemia with the development of infectious complications. METHODS This is a retrospective cohort involving adult Filipino ALL patients admitted at a tertiary referral center. Patients were stratified according to blood glucose levels and infections were classified into microbiologically and clinically defined infections. Logistic regression was performed to determine whether hyperglycemia was associated with the development of infectious complications. RESULTS Of the 174 patients admitted for ALL, only 76 patients (44%) underwent blood glucose monitoring and were thus included in this study. Hyperglycemia was observed in 64 patients (84.21%). Infectious complications were seen in 56 patients (73.68%), of whom 37 patients (48.68%) had microbiologically defined infections and 19 (25%) had clinically defined infections. The respiratory tract was the most common site of infection and gram-negative bacteria were the predominant isolates. Hyperglycemia significantly increased the likelihood of infectious complications, particularly at blood glucose levels ≥ 200 mg/dL. CONCLUSION Hyperglycemia is associated with an increased likelihood of infectious complications in Filipino ALL patients. With sepsis being one of the main causes of mortality in this population, our study provides compelling evidence for us to consider routine blood glucose monitoring in order to manage and potentially decrease the occurrence of infections in these patients.
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ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, Collins BS, Hilliard ME, Isaacs D, Johnson EL, Kahan S, Khunti K, Leon J, Lyons SK, Perry ML, Prahalad P, Pratley RE, Seley JJ, Stanton RC, Gabbay RA, on behalf of the American Diabetes Association. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes-2023. Diabetes Care 2023; 46:S267-S278. [PMID: 36507644 PMCID: PMC9810470 DOI: 10.2337/dc23-s016] [Citation(s) in RCA: 45] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Salukhov VV, Minakov AA, Sharypova TG, Kononova AA, Surkhaeva VA. Сarbohydrate metabolism disorders and their outcomes in the long-term period in hospitalized patients with COVID-19. Diabetes mellitus 2022. [DOI: 10.14341/dm12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND: Diabetes mellitus (DM) is a predisposing factor for the development of many infectious complications. Numerous studies have demonstrated the association of hyperglycemia in patients having DM with a high risk of a more unfavorable course of COVID-19. However, hyperglycemia is often detected in patients with a COVID-19 not having anamnesis of DM. The following remains unclear: the etiological factors causing such disorders of carbohydrate metabolism, the persistence of these disorders and the characteristics of the course, as well as their comparative effect on the outcomes of COVID-19 and the further prognosis of patients.AIM: To study the prevalence and nature of carbohydrate metabolism disorders in patients with moderate to severe course of COVID-19, as well as 6 months after it.MATERIALS AND METHODS: Hospitalized patients with a confirmed diagnosis of COVID-19 of moderate and severe course of the disease were examined. There were no medical interventions outside recommendations of patient management. The observation was carried out during two time periods: inpatient treatment of a COVID-19 and 6 months after discharge. The following were evaluated: anamnesis data, the level of fasting plasma glucose; HbA1c, the results of computed tomography of the lungs, the drug therapy taken in all patients. Descriptive statistics methods were used to evaluate the parameters.RESULTS: The study included 280 patients with a median age of 61.5±14,2 years. During the disease, a violation of carbohydrate metabolism was detected in 188 people (67%), the remaining patients (33%) made up the normoglycemia group. Patients with hyperglycemia were stratified in a following way: a group with an established diagnosis of DM before COVID -19 included — 56 people (20%), a group with steroid-induced hyperglycemia (SIH) — 95 people (34%), a group of stress- induced hyperglycaemia — 20 people (7%), with undiagnosed diabetes — 17 people (6%). In the postcovid period (after 6 months), the normal level of glycemia in the same sample group was observed in 199 people (71.4%); 8 people (3%) were diagnosed with new cases of DM. The mortality rate was 10 people (3.6%) in the group of SIH (8 people) and undiagnosed DM (2 people).CONCLUSION: The use of glucocorticoids in hospitalized patients with COVID-19 leads to high incidence of SIH, which has reversible character. About 6% among hospitalized patients with a COVID-19 had undiagnosed DM and were not receiving antihyperglycemic therapy. The highest mortality was noted in the group of SIH, which allows us to conclude that SIH worsens the prognosis of patients to the greatest extent. Patients with newly diagnosed hyperglycemia, regardless of the level of hyperglycemia, are characterized by a more unfavorable course.
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Glaser N, Fritsch M, Priyambada L, Rewers A, Cherubini V, Estrada S, Wolfsdorf JI, Codner E. ISPAD clinical practice consensus guidelines 2022: Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes 2022; 23:835-856. [PMID: 36250645 DOI: 10.1111/pedi.13406] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 01/01/2023] Open
Affiliation(s)
- Nicole Glaser
- Department of Pediatrics, Section of Endocrinology, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Maria Fritsch
- Department of Pediatric and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Austria Medical University of Graz, Graz, Austria
| | - Leena Priyambada
- Division of Pediatric Endocrinology, Rainbow Children's Hospital, Hyderabad, India
| | - Arleta Rewers
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | - Sylvia Estrada
- Department of Pediatrics, Division of Endocrinology and Metabolism, University of the Philippines, College of Medicine, Manila, Philippines
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Ethel Codner
- Institute of Maternal and Child Research, School of Medicine, University of Chile, Santiago, Chile
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Abstract
Glucocorticoid hormones were discovered to have use as potent anti-inflammatory and immunosuppressive therapeutics in the 1940s and their continued use and development have successfully revolutionized the management of acute and chronic inflammatory diseases. However, long-term use of glucocorticoids is severely hampered by undesirable metabolic complications, including the development of type 2 diabetes mellitus. These effects occur due to glucocorticoid receptor activation within multiple tissues, which results in inter-organ crosstalk that increases hepatic glucose production and inhibits peripheral glucose uptake. Despite the high prevalence of glucocorticoid-induced hyperglycaemia associated with their routine clinical use, treatment protocols for optimal management of the metabolic adverse effects are lacking or underutilized. The type, dose and potency of the glucocorticoid administered dictates the choice of hypoglycaemic intervention (non-insulin or insulin therapy) that should be provided to patients. The longstanding quest to identify dissociated glucocorticoid receptor agonists to separate the hyperglycaemic complications of glucocorticoids from their therapeutically beneficial anti-inflammatory effects is ongoing, with selective glucocorticoid receptor modulators in clinical testing. Promising areas of preclinical research include new mechanisms to disrupt glucocorticoid signalling in a tissue-selective manner and the identification of novel targets that can selectively dissociate the effects of glucocorticoids. These research arms share the ultimate goal of achieving the anti-inflammatory actions of glucocorticoids without the metabolic consequences.
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Affiliation(s)
- Jia-Xu Li
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Carolyn L Cummins
- Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.
- Banting and Best Diabetes Centre, University of Toronto, Toronto, ON, Canada.
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Gómez-Huelgas R, Gómez-Peralta F. Perceptions about the Management of Patients with DM2 and COVID-19 in the Hospital Care Setting. J Clin Med 2022; 11:jcm11154507. [PMID: 35956122 PMCID: PMC9369585 DOI: 10.3390/jcm11154507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/20/2022] [Accepted: 07/30/2022] [Indexed: 02/08/2023] Open
Abstract
Background: COVID-19 entails a higher rate of complications in subjects with type 2 diabetes mellitus (T2DM). Likewise, COVID-19 infection can cause alterations in glucose metabolism that may lead to worse control. The aim of the study was to analyse the perceptions of a large group of Spanish physicians about the relationship between COVID-19 and T2DM, as well as the management, monitoring, and treatment of both diseases. Methods: A cross-sectional multicenter national project was conducted based on a survey which included opinion, attitude, and behavior (OAB) questions. Physicians specialised in internal medicine or endocrinology, whose usual clinical practices included the management of T2DM, responded to the survey between March and April 2021. Results: A total of 112 participants responded to the survey, from which 64.3% believed that COVID-19 entailed a higher risk of glycaemic decompensation irrespective of the presence of previously known T2DM. Obesity was considered a risk factor for poor control of T2DM by 57.7% and for a worse course of COVID-19 by 61.0%. Treatment intensification in not-on-target patients was considered by 57.1% in the presence of COVID-19 and by 73.2% in the absence of COVID-19. No participants considered the suspension of dipeptidyl peptidase 4 inhibitors (DPP-4i) in ambulatory patients, 85.7% declared that this therapeutic approach in hospitalized patients should be kept, and 88.4% supported the option of maintaining DPP-4i when corticosteroids were prescribed. Conclusion: The physicians involved in the management of T2DM and COVID-19 are aware of the bidirectional relationship between both conditions. However, the monitoring and therapeutic management of patients with T2DM who are infected by SARS-CoV-2 needs improvement through the following of the current recommendations and available evidence.
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Affiliation(s)
- Ricardo Gómez-Huelgas
- Servicio de Medicina Interna, Hospital Regional Universitario, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), 29010 Málaga, Spain
- Correspondence:
| | - Fernando Gómez-Peralta
- Unidad de Endocrinología y Nutrición, Hospital General, Calle Luis Erik Clavería Neurólogo S/N, 40002 Segovia, Spain;
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Handattu K, Sharma LK, Vijayasekharan K, Bhat K V, Aroor S, Sudhanshu S. Drug Induced Diabetes Mellitus in Pediatric Acute Lymphoblastic Leukemia: Approach to Diagnosis and Management. J Pediatr Hematol Oncol 2022; 44:273-279. [PMID: 35700365 DOI: 10.1097/mph.0000000000002494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/08/2022] [Indexed: 11/26/2022]
Abstract
Corticosteroids and l -asparaginase used in the treatment of pediatric acute lymphoblastic leukemia (ALL) can cause drug-induced diabetes mellitus (DIDM). DIDM can lead to dyselectrolytemia, a higher risk of infections including cellulitis, bacteremia, fungemia, and a higher incidence of febrile neutropenia and may have an impact on the outcome of ALL. Literature on the management of DIDM among children with ALL is sparse and the diagnostic criteria for pediatric diabetes should be carefully applied considering the acute and transient nature of DIDM during ALL therapy. Insulin remains the standard of care for DIDM management and the choice of Insulin regimen (stand-alone Neutral Protamine Hagedorn or basal bolus) should be based on the type and dose of steroids used for ALL and the pattern of hyperglycemia. A modest glycemic control (postmeal 140 to 180 mg/dL, premeal <140 mg/dL) to prevent complications of hyperglycemia, as well as hypoglycemia, would be the general approach. This review is intended to suggest evidence-based practical guidance in the diagnosis and management of DIDM during pediatric ALL therapy.
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Affiliation(s)
| | - Lokesh K Sharma
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
| | | | - Vasudeva Bhat K
- Division of Pediatric Hematology and Oncology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka
| | | | - Siddhnath Sudhanshu
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh
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24
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Brooks D, Schulman-Rosenbaum R, Griff M, Lester J, Low Wang CC. Glucocorticoid-Induced Hyperglycemia Including Dexamethasone-Associated Hyperglycemia in COVID-19 Infection: A Systematic Review. Endocr Pract 2022; 28:1166-1177. [PMID: 35940469 PMCID: PMC9354392 DOI: 10.1016/j.eprac.2022.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 01/08/2023]
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25
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Qian D, Gao H, Chen Y. Efficacy Analysis of Team-Based Nursing Compliance in Young and Middle-Aged Diabetes Mellitus Patients Based on Random Forest Algorithm and Logistic Regression. Computational and Mathematical Methods in Medicine 2022; 2022:1-7. [PMID: 35936376 PMCID: PMC9355774 DOI: 10.1155/2022/3882425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/14/2022] [Accepted: 07/21/2022] [Indexed: 11/18/2022]
Abstract
Objective Long-term hyperglycemia in young and middle-aged diabetic patients can be complicated with diabetic ketoacidosis, stroke, myocardial infarction, infection, and other complications. The objective was to explore the application value of machine learning in predicting the recurrence risk of young and middle-aged diabetes patients with team-based nursing intervention. Methods Clinical data of 80 patients with diabetes treated in the Department of Endocrinology from 2019 to 2020 were retrospectively collected. The data set was divided into 70% training set (n =56) and 30% test set (n =24). All the selected research cases were intervened by the team-based management mode involving family and clinical doctors and nurses. The degree of diabetes knowledge learning, the level of blood glucose changes, and the psychological state of the patients were evaluated. The random forest (RF) algorithm and logistic regression prediction model were constructed to predict the risk factors of diabetes recurrence. Results There was no significant difference in the degree of diabetes knowledge learning, the level of blood glucose changes, and the psychological state between the training set and the test set (P > 0.05). The FPG, HbA1c, and 2hPG of recurrence group patients were significantly higher than those of nonrecurrence group patients, and the difference was statistically significant (P < 0.05). In descending order of importance based on the RF algorithm prediction model were glucose, BMI, age, insulin, pedigree function, skin thickness, and blood diastolic pressure. The accuracy of RF and logistic regression prediction models is 81.46% and 80.21%, respectively. Conclusion The team-based nursing model has a good effect on the blood glucose control level of middle-aged and young diabetic patients. Age, BMI, and glucose values are risk factors for diabetes. The SF algorithm has a good effect on predicting the risk of diabetes, which is worthy of further clinical application.
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Galindo RJ, Dhatariya K, Gomez-Peralta F, Umpierrez GE. Safety and Efficacy of Inpatient Diabetes Management with Non-insulin Agents: an Overview of International Practices. Curr Diab Rep 2022; 22:237-246. [PMID: 35507117 PMCID: PMC9065239 DOI: 10.1007/s11892-022-01464-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE OF REVIEW The field of inpatient diabetes has advanced significantly over the last 20 years, leading to the development of personalized treatment approaches. However, outdated guidelines still recommend the use of basal-bolus insulin therapy as the preferred treatment approach, and against the use of non-insulin anti-hyperglycemic agents. RECENT FINDINGS Several observational and prospective randomized controlled studies have demonstrated that oral anti-hyperglycemic agents are widely used in the hospital, including studies of DPP-4 agents and GLP-1 agonists. With advances in the field of inpatient diabetes management, a paradigm shift has occurred, from an approach of recommending "basal-bolus regimens" for all patients to a more precision medicine option for hospitalized non-critically ill patients with type 2 diabetes.
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Affiliation(s)
- Rodolfo J Galindo
- Associate Professor of Medicine, Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, USA.
| | - Ketan Dhatariya
- Consultant Diabetes & Endocrinology / Honorary Professor, Norwich Medical School, Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals, NHS Foundation Trust, Norwich, UK
| | | | - Guillermo E Umpierrez
- Professor of Medicine, Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, USA
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Takahashi Y, Matsuura H, Domi H, Yamamura H. A continuous intravenous insulin infusion protocol to manage high-dose methylprednisolone-induced hyperglycemia in patients with severe COVID-19. Clin Diabetes Endocrinol 2022; 8:4. [PMID: 35477646 PMCID: PMC9044380 DOI: 10.1186/s40842-022-00141-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/11/2022] [Indexed: 11/23/2022] Open
Abstract
Background Many patients with severe COVID-19 have impaired glucose tolerance, and steroid therapy is a standard treatment. Thus, good glycemic control is important and correlates with better patient outcomes. We began using a continuous intravenous insulin infusion protocol for glycemic control whose infusion rate changes based on the currently measured value and previous value. This study aimed to evaluate this protocol for COVID-19 patients requiring mechanical ventilation. Methods This single-center, retrospective, case control study was conducted on all adult patients who required mechanical ventilation for severe COVID-19 pneumonia admitted to our critical care center from April 1, 2020 through June 20, 2021. Blood glucose levels were measured in all patients every 4 h after admission. We started using the insulin infusion protocol from August 1, 2020. Patients before starting the protocol comprised the non-protocol group and those after starting the protocol comprised the protocol group. Blood glucose levels and hypo- or hyperglycemia events were compared between groups. We also surveyed ICU nurses about their experience using the protocol. Results During the study period, 173 patients with COVID-19 were admitted. After 15 patients were excluded for several reasons, the study included 158 patients: non-protocol group (n = 14) and protocol group (n = 144). In the initial phase (days 1–2), blood glucose levels of the protocol group were higher compared with the non-protocol group, and as the number of measurements increased, blood glucose levels were gradually brought under control within the target range in the protocol group. Almost no hypoglycemic events (blood glucose < 80 mg/dL) were detected in either group. The rate of hyperglycemia (blood glucose > 300 mg/dL) was about 5–10% in the initial phase in the protocol group and about 10–15% in the early phase (days 3–4) in the non-protocol group. The questionnaire survey revealed that 80% of ICU nurses responded favorably. Conclusions This insulin protocol gradually brought the blood glucose level within target levels in severe COVID-19 patients treated with high-dose steroid. Some hyperglycemia events were detected despite patients being under the protocol in the initial phase, and thus, minor modifications of the protocol might be required in the initial phase.
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Affiliation(s)
- Yoshihito Takahashi
- Osaka Prefectural Nakakawachi Emergency and Critical Care Center, 3-4-13 Nishiiwata, Higashiosaka, Osaka, 578-0947, Japan
| | - Hiroshi Matsuura
- Osaka Prefectural Nakakawachi Emergency and Critical Care Center, 3-4-13 Nishiiwata, Higashiosaka, Osaka, 578-0947, Japan.
| | - Hisaya Domi
- Osaka Prefectural Nakakawachi Emergency and Critical Care Center, 3-4-13 Nishiiwata, Higashiosaka, Osaka, 578-0947, Japan
| | - Hitoshi Yamamura
- Osaka Prefectural Nakakawachi Emergency and Critical Care Center, 3-4-13 Nishiiwata, Higashiosaka, Osaka, 578-0947, Japan
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Olsen MT, Dungu AM, Klarskov CK, Jensen AK, Lindegaard B, Kristensen PL. Glycemic variability assessed by continuous glucose monitoring in hospitalized patients with community-acquired pneumonia. BMC Pulm Med 2022; 22:83. [PMID: 35264139 PMCID: PMC8905566 DOI: 10.1186/s12890-022-01874-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/25/2022] [Indexed: 01/17/2023] Open
Abstract
Background Glycemic variability (GV) has only been sparsely studied in patients with community-acquired pneumonia (CAP). This study aimed to quantify in-hospital GV in CAP patients, including determining the impact of type 2 diabetes mellitus (T2DM) and glucocorticoid (GC) treatment on GV. Methods This is a prospective cohort study of CAP patients (N = 40) with or without T2DM and treated or not with GCs. The primary endpoint was GV measured as glucose standard deviation (SD), coefficient of variation (CV), and postprandial glucose excursions (PPGE) based on continuous glucose monitoring (CGM). Analysis of glucose data was split into daytime and nighttime when possible. Results Patients included had a mean age of 74 (range 55 to 91) years. SD (95%CI) increased by a factor of 1.93 (1.40 to 2.66) and 2.29 (1.38 to 3.81) in patients with T2DM and not treated with GCs during the daytime and the nighttime, respectively (both P < 0.01), and by a factor of 1.42 (1.04 to 1.97) in patients treated with GCs but without T2DM during the daytime (P = 0.031) compared to patients without T2DM and not treated with GCs. CV (95%CI) increased by 5.1 (0.0 to 10.1) and 8.1 (1.0 to 15.2) percentage points during the daytime and the nighttime, respectively, in patients with T2DM and not treated with GCs compared to patients without T2DM and not treated with GCs (P = 0.046 and P = 0.026, respectively). PPGE (95% CI) increased during lunch by 2.5 (0.7 to 4.3) mmol/L (45 (13 to 77) mg/dL) in patients with T2DM and treated with GCs compared to patients without T2DM and not treated with GCs (P = 0.018). Conclusions CAP patients receiving GCs, especially those with T2DM, are at great risk of developing high GV and therefore require clinical attention to mitigate GV. This applies particularly during the daytime. Results support the 1 to 2-h post-lunch screening procedure for glucocorticoid-induced hyperglycemia in patients without diabetes. SD was positively correlated with hospital length of stay. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01874-7.
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Affiliation(s)
- Mikkel Thor Olsen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.
| | - Arnold Matovu Dungu
- Department of Pulmonary- and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Carina Kirstine Klarskov
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Andreas Kryger Jensen
- Biostatistics, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.,Department of Clinical Research, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Birgitte Lindegaard
- Department of Pulmonary- and Infectious Diseases, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
| | - Peter Lommer Kristensen
- Department of Endocrinology and Nephrology, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University Hospital - North Zealand, Hilleroed, Denmark
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Kandil I, Keely E. Glucocorticoid-Induced Hyperglycemia in Oncologic Outpatients: A Narrative Review Using the Quadruple Aim Framework. Can J Diabetes 2022; 46:S1499-2671(22)00023-5. [PMID: 36055914 DOI: 10.1016/j.jcjd.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/04/2022] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
Abstract
Glucocorticoids are a central part of cancer treatment protocols. Their use in patients receiving chemotherapy increases patient risk of hyperglycemia and associated adverse outcomes. Despite this, there have been few published protocols that guide the management of this patient group. In this narrative review, we use the quadruple aim as a framework to evaluate the current literature, including interventions, on glucocorticoid-induced hyperglycemia in patients receiving oncologic treatment, with a focus on the outpatient setting. Findings were drawn from published review articles, observational studies, qualitative reports and costing data. Results were synthesized using the framework's 4 dimensions of care: population health, provider experience, patient experience and cost. Prospective studies proposing an intervention on oncologic patients receiving glucocorticoids were identified as intervention studies. Management of glucocorticoid-induced hyperglycemia in oncologic patients is a complex problem with no published interventions addressing all components of the quadruple aim. Most evidence on this population is based on retrospective studies. Six prospective intervention studies were identified and highlighted in this review, and only 2 were exclusively in the outpatient context. Challenges included lack of standardization in screening strategies, paucity of interventions that have examined impact on patient and provider experience. There is limited evaluation of the impact of interventions targeting glycemic control on clinical outcomes and cost of care delivery, especially in the outpatient context. We propose a conceptual framework for evaluation of quality improvement programs. Management of glucocorticoid-induced hyperglycemia in the outpatient setting is complex and requires well-designed intervention studies evaluated across the quadruple aim.
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Affiliation(s)
- Ihab Kandil
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Endocrinology and Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada.
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Abstract
Hintergrund Eine Hyperglykämie bei Menschen mit und ohne Diabetes, die ins Krankenhaus eingeliefert werden, ist mit einem erheblichen Anstieg von Morbidität, Mortalität und Gesundheitskosten verbunden. Während eines Krankenhausaufenthaltes treten Stoffwechseldekompensationen häufig als Folge unterschiedlicher Ereignisse oder Zusatztherapien auf. Aufgrund des erhöhten Risikos für eine Zunahme der Morbidität, verbunden mit längerem Krankenhausaufenthalt sowie höheren Kosten und Mortalität, erscheint eine genaue Betrachtung der Bedeutung von Glukosewerten und der Therapieformen im Krankenhaus sinnvoll und angebracht. Material und Methode Aktuelle Befunde, Übersichtsarbeiten und Grundlagendaten wurden analysiert und in einer kurzen Übersicht zusammengefasst und diskutiert. Fazit Eine persistierende Hyperglykämie im Krankenhaus ist häufig und oft mit unzureichenden Ergebnissen des Krankenhausaufenthaltes verbunden. Die kontinuierliche Insulininfusion bleibt die Therapie der Wahl während hyperglykämischer Krisen und kritischen Erkrankungen. Auch bei nicht kritisch kranken Menschen mit ausgeprägter Hyperglykämie, schon ambulant bekannten hohen Insulindosen, mit Typ-1-Diabetes oder mit steroidinduzierter Hyperglykämie bleibt Insulin das Mittel der Wahl.
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Affiliation(s)
- Michael Jecht
- Diabetesschwerpunktpraxis, Rodensteinstr. 32, 13593 Berlin, Deutschland
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Mendes TB, Câmara-de-Souza AB, Halpern B. Hospital management of hyperglycemia in the context of COVID-19: evidence-based clinical considerations. Diabetol Metab Syndr 2022; 14:37. [PMID: 35246230 PMCID: PMC8895065 DOI: 10.1186/s13098-022-00808-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 02/18/2022] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic led to an unprecedented crisis, and early on, it has been shown that diabetes is an important risk factor for complications and mortality in infected patients, as demonstrated by several studies. Moreover, hyperglycemia, regardless of whether patients have diabetes, is associated with poorer outcomes, which suggests that adequate monitoring and treatment of elevated glycemia in the hospital setting can improve patient outcomes. In patients with COVID-19, glycemic control may be impaired as a consequence of the infection itself (aggravating pre-existing diabetes and potentially precipitating new-onset diabetes), inflammation, or corticosteroid use-a well-established therapy to reduce COVID-19 complications, especially in the intensive care unit. This article reviews the link between diabetes and hyperglycemia, and COVID-19, with a brief review of potential mechanisms, along with emerging evidence on the effect of glycemic control on COVID-19 outcomes, especially in hospital settings.
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Affiliation(s)
- Thiago Bosco Mendes
- Department of Internal Medicine, Hospital das Clínicas, São Paulo State University (UNESP), Botucatu, Brazil
| | | | - Bruno Halpern
- Department of Endocrinology, Hospital 9 de Julho, Rua Alves Guimarães, 462, cj. 72, Pinheiros, São Paulo, SP, 05410-000, Brazil.
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Milluzzo A, Manuella L, Cannata E, Russo G, La Vignera S, Purrello F, Di Cataldo A, Sciacca L. Influence of Body Mass Index, Cancer Type and Treatment on Long-Term Metabolic and Liver Outcomes in Childhood Cancer Survivors. J Clin Med 2022; 11:878. [PMID: 35160329 PMCID: PMC8836510 DOI: 10.3390/jcm11030878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 11/25/2022] Open
Abstract
In the last decade, the survival of subjects affected by cancer in childhood has significantly improved. The increased lifespan of childhood cancer survivors (CCS) led to a greater risk for long-term, therapy-related morbidity. To identify the clinical predictors of metabolic adverse outcomes in CCS (average off-therapy period: 12 years), we recruited 126 survivors of different childhood cancers (86.5% hematological cancers) who received at least anticancer chemotherapy, consecutively approached during their annual oncohematological outpatient visit. At examination, anthropometric measures and cancer-related history were collected. Moreover, a fasting venous sample was carried out for measuring fasting plasma glucose and insulin, glycated hemoglobin, lipid panel, and transaminases. We calculated the indexes of insulin resistance (HOMA-IR, McAuley, and QUICKI) and secretion (HOMA-β), liver steatosis (Hepatic Steatosis Index) and fibrosis (FIB-4 and NAFLD fibrosis score), and visceral fat dysfunction (Visceral Adiposity Index). More than one-third of the subjects (37.3%) did not have normal weight, with 11.1% of them affected by obesity. At recruitment, obese subjects were at significantly higher risk for impaired fasting glucose, metabolic syndrome, visceral adipose dysfunction, and liver steatosis/fibrosis. Subjects who received bone marrow transplantation were prone to insulin resistance, while survivors of lymphoma presented a visceral adipose dysfunction These results suggest a carefully metabolic monitoring of CCS, particularly in subgroups at higher risk, to early detect these conditions, promptly begin therapeutic interventions, and mitigate the dysmetabolic-related health burden.
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Affiliation(s)
- Agostino Milluzzo
- Department of Clinical and Experimental Medicine, Endocrinology, University of Catania Medical School, 95122 Catania, Italy; (A.M.); (L.M.)
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, 95122 Catania, Italy
| | - Lucia Manuella
- Department of Clinical and Experimental Medicine, Endocrinology, University of Catania Medical School, 95122 Catania, Italy; (A.M.); (L.M.)
| | - Emanuela Cannata
- Department of Clinical and Experimental Medicine, Paediatric Oncohematology Unit, University of Catania Medical School, 95122 Catania, Italy; (E.C.); (G.R.); (A.D.C.)
| | - Giovanna Russo
- Department of Clinical and Experimental Medicine, Paediatric Oncohematology Unit, University of Catania Medical School, 95122 Catania, Italy; (E.C.); (G.R.); (A.D.C.)
| | - Sandro La Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Policlinico “G. Rodolico”, 95123 Catania, Italy;
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, 95123 Catania, Italy;
| | - Andrea Di Cataldo
- Department of Clinical and Experimental Medicine, Paediatric Oncohematology Unit, University of Catania Medical School, 95122 Catania, Italy; (E.C.); (G.R.); (A.D.C.)
| | - Laura Sciacca
- Department of Clinical and Experimental Medicine, Endocrinology, University of Catania Medical School, 95122 Catania, Italy; (A.M.); (L.M.)
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Heckmann JG. Therapie der idiopathischen Fazialisparese („Bell’s palsy“). DGNeurologie 2022; 5:449-465. [DOI: 10.1007/s42451-022-00489-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Joharatnam-Hogan N, Chambers P, Dhatariya K, Board R. A guideline for the outpatient management of glycaemic control in people with cancer. Diabet Med 2022; 39:e14636. [PMID: 34240470 DOI: 10.1111/dme.14636] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/17/2022]
Abstract
Individuals with cancer are at increased risk of developing new-onset diabetes mellitus and hyperglycaemia, and an estimated 20% of people with cancer already have an underlying diagnosis of diabetes mellitus. People with both cancer and diabetes may have an increased risk of toxicities, hospital admissions and morbidity, with hyperglycaemia potentially attenuating the efficacy of chemotherapy often secondary to dose reductions and early cessation. Numerous studies have demonstrated that hyperglycaemia is prognostic of worse overall survival and risk of cancer recurrence. These guidelines aim to provide the oncology/haemato-oncology and diabetes multidisciplinary teams with the tools to manage people with diabetes commencing anti-cancer/glucocorticoid therapy, as well as identifying individuals without a known diagnosis of diabetes who are at risk of developing hyperglycaemia and new-onset diabetes.
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Affiliation(s)
| | - Pinkie Chambers
- University College London Hospital NHS Foundation Trust, London, UK
| | - Ketan Dhatariya
- Norfolk and Norwich Hospitals NHS Foundation Trust, London, UK
| | - Ruth Board
- Lancashire Teaching Hospitals NHS Foundation Trust, London, UK
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Shah P, Kalra S, Yadav Y, Deka N, Lathia T, Jacob JJ, Kota SK, Bhattacharya S, Gadve SS, Subramanium KAV, George J, Iyer V, Chandratreya S, Aggrawal PK, Singh SK, Joshi A, Selvan C, Priya G, Dhingra A, Das S. Management of Glucocorticoid-Induced Hyperglycemia. Diabetes Metab Syndr Obes 2022; 15:1577-1588. [PMID: 35637859 PMCID: PMC9142341 DOI: 10.2147/dmso.s330253] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 02/09/2022] [Indexed: 01/25/2023] Open
Abstract
Glucocorticoids are potent immunosuppressive and anti-inflammatory drugs used for various systemic and localized conditions. The use of glucocorticoids needs to be weighed against their adverse effect of aggravating hyperglycemia in persons with diabetes mellitus, unmask undiagnosed diabetes mellitus, or precipitate glucocorticoid-induced diabetes mellitus appearance. Hyperglycemia is associated with poor clinical outcomes, including infection, disability after hospital discharge, prolonged hospital stay, and death. Furthermore, clear guidelines for managing glucocorticoid-induced hyperglycemia are lacking. Therefore, this consensus document aims to develop guidance on the management of glucocorticoid-induced hyperglycemia. Twenty expert endocrinologists, in a virtual meeting, discussed the evidence and practical experience of real-life management of glucocorticoid-induced hyperglycemia. The expert group concluded that we should be proactive in terms of diagnosis, management, and post-steroid care. Since every patient has different severity of underlying disease, clinical stratification would help understand patient profiles and determine the treatment course. Patients at home with pre-existing diabetes who are already on oral or injectable therapy can continue the same as long as they are clinically stable and eating adequately. However, depending on the degree of hyperglycemia, modification of doses may be required. Initiating basal bolus with correction regimen is recommended for patients in non-intensive care unit settings. For patients in intensive care unit, variable rate intravenous insulin infusion could be temporarily used, but under supervision of diabetes inpatient team, and patients can be transitioned to subcutaneous insulin once stable baseline assessment and continual evaluation are crucial for day-to-day decisions concerning insulin doses. Glycemic variability should be carefully monitored, and interventions to treat patients should also aim at achieving and maintaining euglycemia. Rational use of glucose-lowering drugs is recommended and treatment regimen should ensure maximum safety for both patient and provider. Glucovigilance is required as the steroids taper during transition, and insulin dosage should be reduced subsequently. Increased clinical and economic burden resulting from corticosteroid-related adverse events highlights the need for effective management. Therefore, these recommendations would help successfully manage GC-induced hyperglycemia and judiciously allocate resources.
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Affiliation(s)
- Parag Shah
- Department of Endocrinology, Gujarat Endocrine Centre, Ahmedabad, Gujarat, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital & B.R.I.D.E, Karnal, Haryana, India
- Correspondence: Sanjay Kalra, Kunjpura Road, Model Town, Near State Bank of India, Sector 12, Karnal, Haryana, 132001, India, Tel +9215848555, Email
| | - Yogesh Yadav
- Department of Endocrinology, MAX Super Specialty Hospital, Dehradun, Uttarakhand, India
| | - Nilakshi Deka
- Department of Endocrinology, Apollo Hospital & Dispur Polyclinic and Nursing Home, Guwahati, West Bengal, India
| | - Tejal Lathia
- Department of Endocrinology, Apollo Hospital, Mumbai, Maharashtra, India
| | | | - Sunil Kumar Kota
- Department of Endocrinology, Diabetes and Endocrine Clinic, Berhampur, Orissa, India
| | - Saptrishi Bhattacharya
- Department of Endocrinology, OeHealth Diabates & Endocrinology Centre, Delhi, Delhi, India
| | - Sharvil S Gadve
- Department of Endocrinology, Excel Endocrine Centre, Kolhapur, Maharashtra, India
| | - K A V Subramanium
- Department of Endocrinology, Visakha Diabates & Endocrine Centre, Vishakhapatnam, Andhra Pradesh, India
| | - Joe George
- Department of Endocrinology, Endodiab Clinic, Calicut, Kerala, India
| | - Vageesh Iyer
- Department of Endocrinology, St.John’s Medical College & Hospital, Bangalore, Karnataka, India
| | - Sujit Chandratreya
- Department of Endocrinology, Endocare Clinic, Nashik, Maharashtra, India
| | - Pankaj Kumar Aggrawal
- Department of Endocrinology, Hormone Care & Research Centre, Ghaziabad, Uttar Pradesh, India
| | | | - Ameya Joshi
- Department of Endocrinology, Endocrine and Diabetes Clinic, Mumbai, Maharashtra, India
| | - Chitra Selvan
- Department of Endocrinology, Ramaiah Memorial Hospital, Bangalore, Karnataka, India
| | - Gagan Priya
- Department of Endocrinology, IVY Hospital, Chandigarh, Punjab, India
| | - Atul Dhingra
- Department of Endocrinology, Bansal Hospital, Sri Ganganagar, Rajasthan, India
| | - Sambit Das
- Department of Endocrinology, Endeavour Clinic, Bhubaneshwar, Orissa, India
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Fourcade G, Lugosi M, Bouillet L. Évaluation de la prévention des effets indésirables de la corticothérapie systémique en consultation de médecine interne au CHUGA. Rev Med Interne 2021; 42:A333-A334. [DOI: 10.1016/j.revmed.2021.10.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Zhou K, Buehler LA, Zaw T, Bena J, Lansang MC. Weight-Based Insulin During and After Intravenous Insulin Infusion Reduces Rates of Rebound Hyperglycemia When Transitioning to Subcutaneous Insulin in the Medical Intensive Care Unit. Endocr Pract 2021; 28:173-178. [PMID: 34687910 DOI: 10.1016/j.eprac.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/23/2021] [Accepted: 10/13/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Hyperglycemia often occurs after the transition from intravenous insulin infusion (IVII) to subcutaneous insulin. Weight-based basal insulin initiated earlier in the course of IVII in the medical intensive care unit (MICU), and a weight-based basal-bolus regimen after IVII, can potentially improve post-IVII glycemic control by 48 hours. METHODS This prospective study included 69 patients in MICU who were on IVII for ≥24 hours. Exclusions were end-stage renal disease, type 1 diabetes mellitus, and the active use of vasopressors. The intervention group received weight-based basal insulin (0.2-0.25 units/kg) with IVII and weight-based bolus insulin after IVII. The control group received current care. The primary end points were glucose levels at specific time intervals up to 48 hours after IVII. RESULTS There were 25 patients in the intervention group and 44 in the control group. The mean age of the patients was 59 ± 15 years, 32 (47%) were men, and 52 (78%) had prior diabetes mellitus. The 2 groups were not different (acute kidney injury/chronic kidney disease, pre-existing diabetes mellitus, illness severity, or nothing by mouth status after IVII), except for the steroid use, which was higher in the control group than in the intervention group (34% vs 12%, respectively). Glucose levels were not lower until 36 to 48 hours after IVII (166.8 ± 39.1 mg/dL vs 220.0 ± 82.9 mg/dL, P < .001). When controlling for body mass index, nutritional status, hemoglobin A1C, and steroid use, glucose level was lower starting at 12 to 24 hours out (166.87 mg/dL vs 207.50 mg/dL, P = .015). The frequency of hypoglycemia was similar between the 2 groups (5.0% vs 7.1%). The study did not reach target enrollment. CONCLUSION The addition of weight-based basal insulin during, and basal-bolus insulin immediately after, IVII in MICU results in better glycemic control at 24 hours after IVII with no increased hypoglycemia.
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Affiliation(s)
- Keren Zhou
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, Ohio.
| | - Lauren Anne Buehler
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, Ohio
| | - Tin Zaw
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
| | - James Bena
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - M Cecilia Lansang
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, Ohio
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Wangnoo S, Shunmugavelu M, Reddy SVB, Negalur V, Godbole S, Dhandhania VK, Krishna N, Gaurav K. Role of Gliclazide in safely navigating type 2 diabetes mellitus patients towards euglycemia: Expert opinion from India. Endocrine and Metabolic Science 2021. [DOI: 10.1016/j.endmts.2021.100102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Stone AC, Dungan K, Gaborcik JW. Insulin NPH for steroid-induced hyperglycemia: Predictors for success. Pharmacotherapy 2021; 41:804-810. [PMID: 34420221 DOI: 10.1002/phar.2616] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/29/2021] [Accepted: 08/12/2021] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVE This study aimed to evaluate the efficacy of insulin neutral protamine Hagedorn (NPH) for steroid-induced hyperglycemia and identify factors associated with achievement of euglycemia. DESIGN Retrospective, single center, cohort analysis. SETTING Quaternary care academic medical center. PATIENTS Adult patients with steroid-induced hyperglycemia on combination therapy of an intermediate-acting steroid and once daily NPH. INTERVENTION The primary outcome was the percentage of patients who achieved euglycemia on day 3 of combination therapy. Patients were divided into euglycemic and dysglycemic cohorts based on the primary outcome. Univariate analysis on baseline characteristics, NPH dose, and steroid dose based on prednisone equivalent dose (PED) was conducted to identify differences between the cohorts. Safety analysis was conducted to detect differences between the two cohorts. MEASUREMENTS AND MAIN RESULTS Of 142 patients included in the primary analysis, 50 (35.2%) achieved euglycemia on day 3 of combination therapy. In univariate analysis, patients who achieved euglycemia had significantly higher median NPH dose standardized to steroid dose on day 1 (0.5 units/mg PED [25%-75% interquartile range (IQR) 0.4-0.8] vs 0.4 units/mg PED [0.2-0.8]; p = 0.046), lower median blood glucose prior to combination therapy on day 3 (111 mg/dl [96-160] vs 136 mg/dl [113-198]; p = 0.008), and lower median blood glucose 4 hours after administration of combination therapy on day 3 (147 mg/dl [116-197] vs 190 mg/dl [153-245]; p = 0.003) compared to patients who did not achieve euglycemia, respectively. Hypoglycemia and life-threatening hypoglycemia occurred at similar rates between the two cohorts. CONCLUSIONS Neutral protamine Hagedorn is a safe and efficacious option for acute care hospitalized patients experiencing steroid-induced hyperglycemia. More aggressive dosing initiation of NPH based on steroid dose may allow for earlier achievement of euglycemia without a difference in hypoglycemia.
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Affiliation(s)
- Andrew C Stone
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kathleen Dungan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Joshua W Gaborcik
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Valenzano M, Lepore G, Grassi G. Challenging steroid-induced worsening of hyperglycaemia in type 1 diabetes with advanced hybrid closed-loop systems. Acta Diabetol 2021; 58:1127-1129. [PMID: 33907873 DOI: 10.1007/s00592-021-01724-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 04/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Marina Valenzano
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medical Sciences, A.O.U. Città della Salute e della Scienza- Le Molinette Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy.
| | - Giuseppe Lepore
- Unit of Endocrine Diseases and Diabetology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127, Bergamo, Italy
| | - Giorgio Grassi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medical Sciences, A.O.U. Città della Salute e della Scienza- Le Molinette Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy
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Thorne I, Steele S, Martineau M, Girling J. Case series of COVID-19 infection in pregnancy complicated by ketoacidosis and symptomatic breathlessness. Obstet Med 2021; 15:50-53. [PMID: 35437450 PMCID: PMC9008316 DOI: 10.1177/1753495x211024511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/24/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022] Open
Abstract
Background The differential diagnosis of acute shortness of breath in a pregnant woman
with COVID-19 is broad. Pregnancy is a ketosis-prone state, which can result
in metabolic acidosis and tachypnoea. Methods We describe four pregnant women with COVID-19 and breathlessness where
ketoacidosis was found to contribute to symptomatic tachypnoea. Results One patient did not have associated COVID-19 pneumonitis, but presented with
severe tachypnoea and metabolic acidosis; three women had pneumonitis and
metabolic acidosis. Corrective treatment for the metabolic abnormalities
resulted in resolution of the ketoacidosis in all cases. No women had
coexistent diabetes. Conclusion This is the first series of COVID-19 in pregnancy complicated by ketoacidosis
and symptomatic tachypnoea. Ketoacidosis associated with COVID-19 is an
important cause of tachypnoea requiring specific treatment, which should not
be overlooked. Potential mechanisms for this are discussed with a framework
for interpretation of blood gas results during pregnancy.
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Affiliation(s)
- Iona Thorne
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex Hospital, London, UK
| | - Samantha Steele
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex Hospital, London, UK
| | - Marcus Martineau
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex Hospital, London, UK
| | - Joanna Girling
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex Hospital, London, UK
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Hussain S, Moorthy M. Managing hyperglycaemia in inpatients. Clin Med (Lond) 2021; 21:e332-e336. [DOI: 10.7861/clinmed.2021-0367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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James J. Dying, dignity and diabetes. Practical Diabetes 2021. [DOI: 10.1002/pdi.2340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- June James
- MSc, BA, RN, NMP, Independent Nurse Consultant, Trend Diabetes, Honorary Associate Professor, University of Leicester, Leicester, UK
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Aberer F, Hochfellner DA, Sourij H, Mader JK. A Practical Guide for the Management of Steroid Induced Hyperglycaemia in the Hospital. J Clin Med 2021; 10:2154. [PMID: 34065762 DOI: 10.3390/jcm10102154] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 01/08/2023] Open
Abstract
Glucocorticoids represent frequently recommended and often indispensable immunosuppressant and anti-inflammatory agents prescribed in various medical conditions. Despite their proven efficacy, glucocorticoids bear a wide variety of side effects among which steroid induced hyperglycaemia (SIHG) is among the most important ones. SIHG, potentially causes new-onset hyperglycaemia or exacerbation of glucose control in patients with previously known diabetes. Retrospective data showed that similar to general hyperglycaemia in diabetes, SIHG in the hospital and in outpatient settings detrimentally impacts patient outcomes, including mortality. However, recommendations for treatment targets and guidelines for in-hospital as well as outpatient therapeutic management are lacking, partially due to missing evidence from clinical studies. Still, SIHG caused by various types of glucocorticoids is a common challenge in daily routine and clinical guidance is needed. In this review, we aimed to summarize clinical evidence of SIHG in inpatient care impacting clinical outcome, establishment of diagnosis, diagnostic procedures and therapeutic recommendations.
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Dobravc Verbič M, Gruban J, Kerec Kos M. Incidence and control of steroid-induced hyperglycaemia in hospitalised patients at a tertiary care centre for lung diseases. Pharmacol Rep 2021; 73:796-805. [PMID: 33651365 PMCID: PMC7920847 DOI: 10.1007/s43440-021-00234-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 01/08/2023]
Abstract
Background The aim of this study was to determine the incidence of steroid-induced hyperglycaemia (SIH) in patients hospitalised at the tertiary centre for lung diseases, to assess glycaemic control during hospitalisation, and to determine the factors associated with the control of SIH. Methods A 4-month retrospective study was conducted. All patients who received systemic glucocorticoids for ≥ 2 days during hospitalisation, with ≥ 2 elevated blood glucose (BG) readings, were included in the analysis. SIH control was determined by mean BG levels, the number and proportion of elevated and pronouncedly elevated BG readings, and the number of hypoglycaemic events. Results 60 of 283 patients (21.2%) developed SIH, of which 55 patients were included in further analysis. Mean fasting and daytime BG levels were 7.8 ± 2.9 mmol/l and 10.9 ± 2.2 mmol/l, respectively. 41/55 patients (74.5%) had elevated average BG levels. 45/55 patients (81.8%) had > 5 readings or > 20% of all readings exceeding hyperglycaemia threshold, and 33/55 patients (60.0%) had pronouncedly elevated BG levels on more than one occasion. 6/55 patients (10.9%) experienced more than one hypoglycaemic event or a severe hypoglycaemia. Only 9/55 patients (16.4%) achieved adequate SIH control according to all defined criteria. Pre-existing diabetes and longer duration of hospital treatment with low glucocorticoid dose were significantly associated with poorer glycaemic control (p < 0.001 and p = 0.003, respectively). Conclusions Appropriate SIH management was demonstrated to be challenging. According to the defined criteria, adequate glycaemic control during hospitalisation was not achieved in the large majority of patients with SIH. Supplementary Information The online version contains supplementary material available at 10.1007/s43440-021-00234-2.
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Affiliation(s)
- Matej Dobravc Verbič
- University Clinic of Respiratory and Allergic Diseases Golnik, Golnik 36, 4204, Golnik, Slovenia. .,Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
| | - Jasna Gruban
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva cesta 7, 1000, Ljubljana, Slovenia
| | - Mojca Kerec Kos
- Faculty of Pharmacy, University of Ljubljana, Aškerčeva cesta 7, 1000, Ljubljana, Slovenia
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Limbachia V, Dhatariya KK. Surveillance of diabetes with inpatients on glucocorticoids: are the
JBDS
audit standards being met? Pract Diab 2021. [DOI: 10.1002/pdi.2326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Ketan K Dhatariya
- Norwich Medical School, University of East Anglia Norwich UK
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich UK
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Pasquel FJ, Lansang MC, Dhatariya K, Umpierrez GE. Management of diabetes and hyperglycaemia in the hospital. Lancet Diabetes Endocrinol 2021; 9:174-188. [PMID: 33515493 PMCID: PMC10423081 DOI: 10.1016/s2213-8587(20)30381-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 10/25/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
Hyperglycaemia in people with and without diabetes admitted to the hospital is associated with a substantial increase in morbidity, mortality, and health-care costs. Professional societies have recommended insulin therapy as the cornerstone of inpatient pharmacological management. Intravenous insulin therapy is the treatment of choice in the critical care setting. In non-intensive care settings, several insulin protocols have been proposed to manage patients with hyperglycaemia; however, meta-analyses comparing different treatment regimens have not clearly endorsed the benefits of any particular strategy. Clinical guidelines recommend stopping oral antidiabetes drugs during hospitalisation; however, in some countries continuation of oral antidiabetes drugs is commonplace in some patients with type 2 diabetes admitted to hospital, and findings from clinical trials have suggested that non-insulin drugs, alone or in combination with basal insulin, can be used to achieve appropriate glycaemic control in selected populations. Advances in diabetes technology are revolutionising day-to-day diabetes care and work is ongoing to implement these technologies (ie, continuous glucose monitoring, automated insulin delivery) for inpatient care. Additionally, transformations in care have occurred during the COVID-19 pandemic, including the use of remote inpatient diabetes management-research is needed to assess the effects of such adaptations.
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Affiliation(s)
- Francisco J Pasquel
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
| | - M Cecilia Lansang
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic, Cleveland, OH, USA
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Guillermo E Umpierrez
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Das S, Rastogi A, Harikumar KVS, Dutta D, Sahay R, Kalra S, Ghosh S, Gupta SK, Pandit K, Jabbar PK, Damodaran S, Nagesh VS, Sheikh S, Madhu SV, Bantwal G. Diagnosis and Management Considerations in Steroid-Related Hyperglycemia in COVID-19: A Position Statement from the Endocrine Society of India. Indian J Endocrinol Metab 2021; 25:4-11. [PMID: 34386386 PMCID: PMC8323636 DOI: 10.4103/ijem.ijem_227_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/14/2021] [Indexed: 12/15/2022] Open
Abstract
The current coronavirus disease (COVID-19) pandemic is showing no signs of abatement and result in significant morbidity and mortality in the infected patients. Many therapeutic agents ranging widely between antivirals and anti-inflammatory drugs have been used to mitigate the disease burden. In the deluge of the drugs being used for COVID-19 infection, glucocorticoids (GCs) stand out by reducing mortality amongst in-hospital severe-to-critically ill patients. Health-care practitioners have seen this as a glimmer of hope and started using these drugs more frequently than ever in clinical practice. The fear of mortality in the short term has overridden the concern of adverse long-term consequences with steroid use. The ease of availability, low cost, and apparent clinical improvement in the short term have led to the unscrupulous use of the steroids even in mild COVID-19 patients including self-medication with steroids. The use of GCs has led to the increasing incidence of hyperglycemia and consequent acute complications of diabetic ketoacidosis and mucormycosis in COVID-19 patients. There is an urgent need to dissipate information about optimum management of hyperglycemia during steroid use. In view of this, the Endocrine Society of India has formulated this position statement about the diagnosis and management of hyperglycemia due to the use of GCs in patients with COVID-19 infection.
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Affiliation(s)
- Sambit Das
- Professor of Endocrinology, Hi Tech Medical College and Hospitals, Bhubaneswar, Odisha, India
| | - Ashu Rastogi
- Department of Endocrinology, PGIMER, Chandigarh, India
| | - K. V. S. Harikumar
- Senior Consultant Endocrinologist, Magna Clinics, Hyderabad, Telangana, India
| | - Deep Dutta
- Department of Endocrinology, Cedar Superspecialty Clinics, Dwarka, New Delhi, India
| | - Rakesh Sahay
- Professor of Endocrinology, Osmania Medical College, Hyderabad, Telangana, India
| | - Sanjay Kalra
- Endocrinologist, Bharti Hospital, Karnal, Haryana, India
| | - Sujoy Ghosh
- Department of Endocrinology, IPGME and R, Kolkata, West Bengal, India
| | - Sushil K. Gupta
- Department of Endocrinology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India
| | - Kaushik Pandit
- Consultant Endocrinologist and Diabetologist, Fortis Medical Centre, Kolkata, West Bengal, India
| | - P. K. Jabbar
- Department of Endocrinology, Medical College Trivandrum, Trivandrum, Kerala, India
| | - Suresh Damodaran
- Consultant Diabetologist and Endocrinologist, Ramakrishna Hospital and Harvey speciality clinic, Coimbatore, Tamil Nadu, India
| | - V. Sri Nagesh
- Endocrinologist, Srinagesh Diabetes, Thyroid and Endocrine Clinic, Hyderabad, Telangana, India
| | - Shehla Sheikh
- Consultant Endocrinologist, Nagpada-Mumbai Central, Mumbai, Maharashtra, India
| | - S. V. Madhu
- Department of Endocrinology, University College of Medical Sciences and Guru Teg Bahadur Hospital, New Delhi, India
| | - Ganapathi Bantwal
- Professor of Endocrinology, St Johns Medical College and Hospital, John Nagar, Koramangala, Bengaluru, Karnataka, India
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