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Cited by 38Hyperglycemia and glycemic control in critically ill and hospitalized patientsDiabetes Management and ResearchDiabetes Treatment and Management

Treatment of prednisolone‐induced hyperglycaemia in hospitalized patients: I nsights from a randomized, controlled study

Radhakutty, Anjana, Stranks, Jessica L., Mangelsdorf, Brenda L., Drake, Sophie M., Roberts, Gregory W., Zimmermann, Anthony T., Stranks, Stephen N., Thompson, Campbell H. +1 more·2017·Diabetes Obesity and Metabolism
DOI 10.1111/dom.12859
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Abstract

AIM: Prednisolone causes hyperglycaemia predominantly between midday and midnight. Consequently, glargine-based basal-bolus insulin regimens may under treat daytime hyperglycaemia and cause nocturnal hypoglycaemia. We investigated whether an isophane-based insulin regimen is safer and more effective than a glargine-based regimen in hospitalized patients. MATERIALS AND METHODS: Fifty inpatients prescribed ≥20 mg/day prednisolone acutely with (1) finger prick blood glucose level (BGL) ≥15 mmol/L or (2) BGLs ≥10 mmol/L within the previous 24 hours were randomized to either insulin isophane or glargine before breakfast and insulin aspart before meals. The initial daily insulin dose was 0.5 U/kg bodyweight or 130% of the current daily insulin dose. Glycaemic control was assessed using a continuous glucose monitoring system. RESULTS: On Day 1, there were no significant differences in percentage of time outside a target glucose range of 4 to 10 mmol/L (41.3% ± 5.5% vs 50.0% ± 5.7%, P = .28), mean daily glucose (10.2 ± 0.7 vs 10.8 ± 0.8 mmol/L, P = .57) or glucose <4 mmol/L (2.2% ± 1.1% vs 2.0% ± 1.3%, P = .92) in patients randomized to isophane and glargine. In patients treated for 3 days, the prednisolone dose was reduced ( P = .02) and the insulin dose was increased over time ( P = .02), but the percentage of time outside the 4 to 10 mmol/L glucose range did not differ over time ( P = .45) or between groups ( P = .24). CONCLUSIONS: There were no differences in the efficacy or safety of the isophane and glargine-based insulin regimens. We recommend an initial daily insulin dose of 0.5 units/kg bodyweight if not on insulin, a greater than 30% increase in pre-prednisolone insulin dose and larger insulin dose adjustments in patients with prednisolone-induced hyperglycaemia.

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Authors
Radhakutty, A., Stranks, J. L., Mangelsdorf, B. L., Drake, S. M., Roberts, G. W., Zimmermann, A. T., Stranks, S. N., Thompson, C. H., & Burt, M. G.
Affiliations
  • Flinders University (AU)
  • Lyell McEwin Hospital (AU)
  • Repatriation General Hospital (AU)
  • Flinders Medical Centre (AU)
Corresponding author
Burt, Morton G.
ORCID
Venue
Diabetes Obesity and Metabolism
Publisher
Wiley
Published
2017-02-17
Volume
19
Issue
4
Pages
571-578
ISSN
  • 1462-8902 (ISSN-L)
  • 1463-1326
DOI
10.1111/dom.12859
OpenAlex
W2566948521
Cited by
38
References
34
Citations by year
2026: 6 · 2025: 5 · 2024: 4 · 2023: 6 · 2022: 5 · 2021: 3 · 2020: 2 · 2019: 4 · 2018: 3
FWCI
2.34
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Diabetes Obesity and Metabolism (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Funders
Flinders Medical Centre Foundation
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
isophane insulin, glargine, multiple daily insulin injections, insulin aspart, hospitalized patients, continuous glucose monitoring, glycemic control, nocturnal hypoglycemia, prednisolone dose reduction, insulin dose adjustment
MeSH terms
Insulin Glargine, Aged, Blood Glucose, Drug Administration Schedule, Female, Hospitalization, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Inpatients, Insulin, Insulin, Isophane, Male, Middle Aged, Prednisolone, Treatment Outcome, Insulin Aspart, Meals

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