Efficacy of a basal bolus insulin protocol to treat prednisolone-induced hyperglycaemia in hospitalised patients
Abstract
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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
One study compared glycaemic control of BBI regimen in patients with type 2 DM without prednisolone with those with prednisolone treatment.
“One study compared glycaemic control of BBI regimen in patients with type 2 DM without prednisolone with those with prednisolone treatment.38”
The daily insulin dose was significantly higher in the prednisolone-treated group than in the control group, especially at 12:00 and 17:00.
“In addition, the daily insulin dose was significantly higher in the prednisolone-treated group than in the control group, especially at 12:00 and 17:00.”
The mean daily BGL was significantly higher in the prednisolone group (p<0.001).
“The mean daily BGL was significantly higher in the prednisolone group (p<0.001) (table 2).”
Burt et al studied the effectiveness of a BBI regimen in hospitalised patients with type 2 DM treated with prednisolone in the morning for an acute medical condition compared with those without glucocorticoid treatment.
“Burt et al 38 studied the effectiveness of a BBI regimen in hospitalised patients with type 2 DM treated with prednisolone in the morning for an acute medical condition compared with those without glucocorticoid treatment.”
BGL was significantly higher at 17:00 and 21:00, but not significantly higher at 07:00 and 12:00.
“More specifically, BGL was significantly higher at 17:00 and 21:00, but not significantly higher at 07:00 and 12:00”
The three observational studies were classified as having low, middle, and high ranges of risk of bias.
“The three observational studies were classified as having low,38 middle39 and high40 ranges of risk of bias (online supplementary table 2b).”
In patients with type 2 diabetes mellitus treated with prednisolone, basal-bolus insulin with long-acting insulin resulted in insufficient glycaemic control at 17:00 and 21:00 compared with those without prednisolone treatment.
“Burt et al 38 did find that glycaemic control was insufficient at 17:00 and 21:00 when using BBI with long-acting insulin in patients with type 2 DM treated with prednisolone compared with those without prednisolone treatment.”
Cites
Standards of medical care in diabetes—2014
American Diabetes Association (2014) · Diabetes Care · doi:10.2337/dc14-s014 · Cited by 4,572 · see citing works
Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes
Umpierrez, G. E., Isaacs, S. D., Bazargan, N., You, X., Thaler, L. M., & Kitabchi, A. E. (2002) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jcem.87.3.8341 · Cited by 2,195 · see citing works
Capes, S. E., Hunt, D., Malmberg, K., & Gerstein, H. C. (2000) · The Lancet · doi:10.1016/s0140-6736(99)08415-9 · Cited by 2,187 · see citing works
Capes, S. E., Hunt, D., Malmberg, K., Pathak, P., & Gerstein, H. C. (2001) · Stroke · doi:10.1161/hs1001.096194 · Cited by 1,824 · see citing works
Severe hypoglycemia and risks of vascular events and death
Zoungas, S., Patel, A., Chalmers, J., de Galan, B. E., Li, Q., Billot, L., Woodward, M., Ninomiya, T., Neal, B., MacMahon, S., et al. (2010) · New England Journal of Medicine · doi:10.1056/nejmoa1003795 · Cited by 1,471 · see citing works
Krinsley, J. S. (2003) · Mayo Clinic Proceedings · doi:10.4065/78.12.1471 · Cited by 1,165 · see citing works
Umpierrez, G. E., Hellman, R., Korytkowski, M. T., Kosiborod, M., Maynard, G. A., Montori, V. M., Seley, J. J., & Van den Berghe, G. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-2098 · Cited by 1,126 · see citing works
Umpierrez, G. E., Smiley, D., Jacobs, S., Peng, L., Temponi, A., Mulligan, P., Umpierrez, D., Newton, C., Olson, D., & Rizzo, M. (2011) · Diabetes Care · doi:10.2337/dc10-1407 · Cited by 720 · see citing works
Umpierrez, G. E., Smiley, D., Zisman, A., Prieto, L. M., Palacio, A., Ceron, M., Puig, A., & Mejia, R. (2007) · Diabetes Care · doi:10.2337/dc07-0295 · Cited by 671 · see citing works
Glucocorticoid-induced hyperglycemia
Clore, J. N., & Thurby-Hay, L. (2009) · Endocrine Practice · doi:10.4158/ep08331.rar · Cited by 508 · see citing works
Baker, E. H. (2006) · Thorax · doi:10.1136/thx.2005.051029 · Cited by 415 · see citing works
Continuous monitoring of circadian glycemic patterns in patients receiving prednisolone for COPD
Burt, M. G., Roberts, G. W., Aguilar-Loza, N. R., Frith, P., & Stranks, S. N. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2010-2729 · Cited by 203 · see citing works
Self-citationAcute and 2-week exposure to prednisolone impair different aspects of β-cell function in healthy men
van Raalte, D. H., Nofrate, V., Bunck, M. C., van Iersel, T., Elassaiss Schaap, J., Nässander, U. K., Heine, R. J., Mari, A., Dokter, W. H. A., & Diamant, M. (2010) · European Journal of Endocrinology · doi:10.1530/eje-09-1034 · Cited by 170 · see citing works
Pathways to Quality Inpatient Management of Hyperglycemia and Diabetes: A Call to Action
Draznin, B., Gilden, J. L., Golden, S. H., Inzucchi, S. E., & for the PRIDE investigators (2013) · Diabetes Care · doi:10.2337/dc12-2508 · Cited by 145 · see citing works
Barsheshet, A., Garty, M., Grossman, E., Sandach, A., Lewis, B. S., Gottlieb, S., Shotan, A., Behar, S., Caspi, A., Schwartz, R., et al. (2006) · Archives of Internal Medicine · doi:10.1001/archinte.166.15.1613 · Cited by 110 · see citing works
van Raalte, D. H., Brands, M., van der Zijl, N. J., Muskiet, M. H., Pouwels, P. J. W., Ackermans, M. T., Sauerwein, H. P., Serlie, M. J., & Diamant, M. (2011) · Diabetologia · doi:10.1007/s00125-011-2174-9 · Cited by 109 · see citing works
Schnipper, J. L., Ndumele, C. D., Liang, C. L., & Pendergrass, M. (2009) · Journal of Hospital Medicine · doi:10.1002/jhm.385 · Cited by 96 · see citing works
Burt, M. G., Roberts, G. W., Aguilar-Loza, N. R., & Stranks, S. N. (2013) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2012.0282 · Cited by 83 · see citing works
Self-citationGeorge, J. T., Warriner, D., McGrane, D. J., et al. (2011) · QJM · doi:10.1093/qjmed/hcr046 · Cited by 79 · see citing works
Petersons, C. J., Mangelsdorf, B. L., Jenkins, A. B., Poljak, A., Smith, M., Greenfield, J. R., Thompson, C. H., & Burt, M. G. (2013) · Diabetes Care · doi:10.2337/dc12-2617 · Cited by 61 · see citing works
Self-citationYuen, K. C. J., McDaniel, P. A., & Riddle, M. C. (2012) · Clinical Endocrinology · doi:10.1111/j.1365-2265.2011.04242.x · Cited by 58 · see citing works
Dhital, S. M., Shenker, Y., Meredith, M., & Davis, D. B. (2012) · Endocrine Practice · doi:10.4158/ep11371.or · Cited by 49 · see citing works
Magee, M. H., Blum, R. A., Lates, C. D., & Jusko, W. J. (2002) · British Journal of Clinical Pharmacology · doi:10.1046/j.1365-2125.2002.01567.x · Cited by 44 · see citing works
Roberts, G. W., Aguilar‐Loza, N., Esterman, A., Burt, M. G., & Stranks, S. N. (2012) · Medical Journal of Australia · doi:10.5694/mja11.10853 · Cited by 42 · see citing works
Self-citationYates, C. J., Fourlanos, S., Colman, P. G., & Cohney, S. (2013) · Nephrology Dialysis Transplantation · doi:10.1093/ndt/gft377 · Cited by 42 · see citing works
A Learner-Centered Diabetes Management Curriculum
DeSalvo, D., Greenberg, L., Henderson, C. L., & Cogen, F. (2012) · Diabetes Care · doi:10.2337/dc12-0450 · Cited by 17 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Management of diabetes and hyperglycaemia in the hospital
Pasquel, F. J., Lansang, M. C., Dhatariya, K., & Umpierrez, G. E. (2021) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(20)30381-8 · Cited by 329 · see citing works
Glucocorticoid-Induced Hyperglycemia: A Neglected Problem
Cho, J.-H., & Suh, S. (2024) · Endocrinology and Metabolism · doi:10.3803/enm.2024.1951 · Cited by 63 · see citing works
Hospital insulin protocol aims for glucose control in glucocorticoid-induced hyperglycemia
Grommesh, B., Lausch, M. J., Vannelli, A. J., Mullen, D. M., Bergenstal, R. M., Richter, S. A., & Fish, L. H. (2016) · Endocrine Practice · doi:10.4158/ep15818.or · Cited by 52 · see citing works
Ruiz de Adana, M. S., Colomo, N., Maldonado-Araque, C., Fontalba, M. I., Linares, F., García-Torres, F., Fernández, R., Bautista, C., Olveira, G., de la Cruz, J. L., et al. (2015) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2015.09.015 · Cited by 45 · see citing works
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. (2017) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12859 · Cited by 38 · see citing works
Self-citationTatalovic, M., Lehmann, R., Cheetham, M., Nowak, A., Battegay, E., & Rampini, S. K. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-028914 · Cited by 27 · see citing works
“One study compared glycaemic control of BBI regimen in patients with type 2 DM without prednisolone with those with prednisolone treatment.(38) Another study compared glycaemic control of BBI regimen with SSI regimen.”
ResultCheng, Y.-C., Guerra, Y., Morkos, M., Tahsin, B., Onyenwenyi, C., Fogg, L., & Fogelfeld, L. (2021) · PLOS ONE · doi:10.1371/journal.pone.0256682 · Cited by 12 · see citing works
- Authors
- Burt, M. G., Drake, S. M., Aguilar‐Loza, N. R., Esterman, A., Stranks, S. N., & Roberts, G. W.
- Affiliations
- Flinders University (AU)
- Repatriation General Hospital (AU)
- Southern Adelaide Diabetes and Endocrine Services Repatriation General Hospital Adelaide South Australia Australia
- University of South Australia (AU)
- Corresponding author
- Burt, M. G.
- Venue
- Internal Medicine Journal
- Publisher
- Wiley
- Published
- 2015-03
- Volume
- 45
- Issue
- 3
- Pages
- 261-266
- ISSN
- 1444-0903 (ISSN-L)
- 1445-5994
- OpenAlex
- W1958175956
- Semantic Scholar
- 160e11034eca6aab482b9e0500786da079687b79
- Cited by
- 38
- References
- 26
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 6 · 2020: 2 · 2019: 4 · 2018: 6 · 2017: 3 · 2016: 5 · 2015: 2
- FWCI
- 4.62
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Internal Medicine Journal (publishedVersion)
- PubMed (publishedVersion)
- Funders
- South Australian Health Practitioner Fellowship
- Unit funds
- 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
- multiple daily insulin injections, insulin therapy, hospitalized patients, type 2 diabetes, glycemic control, glycosylated haemoglobin, inflammatory diseases, ultra-rapid-acting insulin, blood glucose variability, insulin dose adjustment, prednisolone
- MeSH terms
- Aged, Aged, 80 and over, Blood Glucose, Cross-Sectional Studies, Diabetes Mellitus, Type 2, Female, Glucocorticoids, Hospitalization, Humans, Hyperglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Prednisolone, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
