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Efficacy of a basal bolus insulin protocol to treat prednisolone‐induced hyperglycaemia in hospitalised patients
Author(s) -
Burt M. G.,
Drake S. M.,
AguilarLoza N. R.,
Esterman A.,
Stranks S. N.,
Roberts G. W.
Publication year - 2015
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12680
Subject(s) - prednisolone , medicine , bolus (digestion) , insulin , diabetes mellitus , gastroenterology , basal (medicine) , type 2 diabetes , endocrinology
Background/Aim Few studies have specifically investigated treatment of prednisolone‐induced hyperglycaemia. Aim To determine if a basal bolus insulin ( BBI ) protocol for inpatient hyperglycaemia is effective in patients prescribed acute prednisolone for an inflammatory disease. Methods In a cross‐sectional study, 66 patients with type 2 diabetes admitted to a general medical ward and treated with BBI for up to 5 days were studied. Twenty‐four patients were taking prednisolone ≥10 mg/day to treat an acute inflammatory disease. The remaining 42 patients were a control group. The primary outcome was mean daily blood glucose level. Results There were no significant differences in glycosylated haemoglobin (8.1 ± 1.0 vs 8.1 ± 1.6%, P = 0.88), age (77 ± 11 vs 75 ± 14 years, P = 0.57), male sex (63 vs 60%, P = 0.81) or body mass index (30.0 ± 5.3 vs 30.2 ± 11.5 kg/m 2 , P = 0.90) between patients taking prednisolone and controls. Mean daily glucose concentration was higher in patients taking prednisolone than in controls (12.2 ± 0.3 vs 10.0 ± 0.1 mmol/L, P < 0.001). Blood glucose level was higher in patients on prednisolone at 1700 h (14.6 ± 0.6 vs 10.3 ± 0.3 mmol/L, P < 0.001) and 2100 h (14.5 ± 0.6 vs 10.5 ± 0.3 mmol/L, P < 0.001), with no significant differences at 0700 h and 1200 h. These findings occurred despite patients taking prednisolone receiving a higher daily insulin dose than controls (0.67–0.70 vs 0.61–0.65 U/kg, P = 0.001) because of higher doses of ultra‐rapid‐acting insulin at 1200 h and 1700 h. Conclusions Hospitalised patients taking prednisolone had substantial afternoon and evening hyperglycaemia despite receiving BBI via a protocol for inpatient hyperglycaemia. Specific insulin regimens for prednisolone‐induced hyperglycaemia are needed that recommend more insulin during this time period.