Management of hyperglycaemia and steroid (glucocorticoid) therapy: a guideline from the Joint British Diabetes Societies ( JBDS ) for Inpatient Care group
Abstract
Glucocorticoids (steroids) are widely used across many medical specialities for their anti‐inflammatory and immunosuppressive properties. However, one of their major side effects is the development of hyperglycaemia. It is well recognized that high glucose levels in people with diabetes in hospital are associated with harm and increased lengths of hospital stay. The use of glucocorticoid (steroid) treatment in people with pre‐existing diabetes will undoubtedly result in worsening glucose control, and this may be termed ‘steroid‐induced hyperglycaemia’, and will warrant temporary additional, and more active, glycaemic management. A rise in glucose may occur in people without a known diagnosis of diabetes, and this may be termed ‘steroid‐induced diabetes’. There is a lack of evidence to guide how people with hyperglycaemia should be managed, and much of the guidance given here is a consensus based on best practice collated from around the United Kingdom. Where evidence is available, this is referenced. These guidelines on the management of people with diabetes treated with steroids has been adapted specifically for Diabetic Medicine . The full version of the guidelines can be found on line at: www.diabetes.org.uk/joint-british-diabetes-society or https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group .
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Recommendations for insulin dosing during glucocorticoid therapy in people with type 1 diabetes remain unclear and inconsistent.
“While certain guidelines offer insulin adjustment recommendations for GC therapy in PWT1D, they remain inconsistent and lack consistency, underscoring the need for a more evidence‐based approach to individualised management. 19 , 24 , 25 , 26 , 27 , 28 , 29 , 30”
From A systematic review of glucocorticoid use in type 1 diabetes: Glycaemic effects and clinical management strategies (2026) · cites this paper as [24]
The Joint British Diabetes Societies for inpatient care guideline and the Imperial College Clinical Guidance recommend up-titration of oral hypoglycaemic agents first, and adding or switching to insulin if blood glucose level remains above 10 mmol/L.
“In contrast, the Joint British Diabetes Societies for inpatient care guideline,19 and the Imperial College Clinical Guidance58 recommend the up-titration of OHA first. They recommend adding19 or switching58 to insulin if BGL remains above 10 mmol/L.”
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- Authors
- Roberts, A., James, J., Dhatariya, K., & Care, T. J. B. D. S. (. F. I.
- Affiliations
- Cardiff and Vale University Health Board (GB)
- University Hospitals of Leicester NHS Trust (GB)
- Norfolk and Norwich University Hospital (GB)
- Corresponding author
- Dhatariya, K.
- ORCID
- Dhatariya, K.
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2018-07-17
- Volume
- 35
- Issue
- 8
- Pages
- 1011-1017
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W2884902719
- Cited by
- 158
- References
- 11
- Citations by year
- 2026: 16 · 2025: 20 · 2024: 26 · 2023: 16 · 2022: 25 · 2021: 22 · 2020: 16 · 2019: 9 · 2018: 3 · 2017: 3 · 2015: 1
- FWCI
- 9.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetic Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Diabetes UK
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- hyperglycemia, glucocorticoids, steroid-induced diabetes, glycemic control, length of hospital stay, corticosteroid adverse effects
- MeSH terms
- Continuity of Patient Care, Diabetes Mellitus, Endocrinology, Glucocorticoids, United Kingdom, Hospitalization, Humans, Hyperglycemia, Inpatients, Patient Discharge, Societies, Medical, Diabetes Complications
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