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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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Struja T, Nitritz N, Alexander I, Kupferschmid K, Hafner JF, Spagnuolo CC, Schuetz P, Mueller B, Blum CA. Treatment of glucocorticoid- induced hyperglycemia in hospitalized patients - a systematic review and meta- analysis. Clin Diabetes Endocrinol 2024; 10:8. [PMID: 38281042 PMCID: PMC10821212 DOI: 10.1186/s40842-023-00158-1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/27/2023] [Indexed: 01/29/2024] Open
Abstract
PURPOSE Glucocorticoid (GC)-induced hyperglycemia is a frequent issue, however there are no specific guidelines for this diabetes subtype. Although treat-to-target insulin is recommended in general to correct hyperglycemia, it remains unclear which treatment strategy has a positive effect on outcomes. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess whether treating GC-induced hyperglycemia improves clinical outcomes. METHODS MEDLINE and EMBASE were systematically searched for RCTs on adults reporting treatment and outcomes of GC-induced hyperglycemia since the beginning of the data bases until October 21, 2023. Glucose-lowering strategies as compared to usual care were investigated. RESULTS We found 17 RCTs with 808 patients and included seven trials in the quantitative analysis. Patients with an intensive glucose-lowering strategy had lower standardized mean glucose levels of - 0.29 mmol/l (95%CI -0.64 to -0.05) compared to usual care group patients. There was no increase in hypoglycemic events in the intensively treated groups (RR 0.91, 95%CI 0.70-1.17). Overall, we did not have enough trials reporting clinical outcomes for a quantitative analysis with only one trial reporting mortality. CONCLUSION In GC-induced hyperglycemia, tight glucose control has a moderate effect on mean glucose levels with no apparent harmful effect regarding hypoglycemia. There is insufficient data whether insulin treatment improves clinical outcomes, and data on non-insulin based treatment regimens are currently too sparse to draw any conclusions. SYSTEMATIC REVIEW REGISTRATION Registered as CRD42020147409 at PROSPERO ( https://www.crd.york.ac.uk/prospero/ ) on April 28, 2020.
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Affiliation(s)
- Tristan Struja
- Department of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital Aarau, Tellstrasse 25, Haus 7, Aarau, 5001, Switzerland
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Neele Nitritz
- Department of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital Aarau, Tellstrasse 25, Haus 7, Aarau, 5001, Switzerland
- Department of Internal Medicine I, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Islay Alexander
- Department of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital Aarau, Tellstrasse 25, Haus 7, Aarau, 5001, Switzerland
| | - Kevin Kupferschmid
- Department of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital Aarau, Tellstrasse 25, Haus 7, Aarau, 5001, Switzerland
| | - Jason F Hafner
- Department of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital Aarau, Tellstrasse 25, Haus 7, Aarau, 5001, Switzerland
| | - Carlos C Spagnuolo
- Department of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital Aarau, Tellstrasse 25, Haus 7, Aarau, 5001, Switzerland
| | - Philipp Schuetz
- Department of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital Aarau, Tellstrasse 25, Haus 7, Aarau, 5001, Switzerland
| | - Beat Mueller
- Department of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital Aarau, Tellstrasse 25, Haus 7, Aarau, 5001, Switzerland
| | - Claudine A Blum
- Department of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital Aarau, Tellstrasse 25, Haus 7, Aarau, 5001, Switzerland.
- Hormonpraxis Aarau, Praxis für Endokrinologie, Diabetologie und Osteologie, Aarau, Switzerland.
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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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