Management of Hyperglycemia in Diabetic Patients with Hematologic Malignancies During Dexamethasone Therapy
Abstract
Objective To compare the response to different insulin regimens for management of hyperglycemia in diabetic patients with hematologic malignancies who are receiving dexamethasone.Methods A retrospective analysis was conducted to determine whether a basal bolus insulin (BBI) regimen with detemir and aspart is superior to a sliding scale regular insulin (SSI) regimen for management of hyperglycemia in hospitalized diabetic patients receiving dexamethasone.Results Forty patients with hematologic malignancies were treated with intravenous (8 to 12 mg/day) or oral (40 mg/day) dexamethasone for 3 days. The average blood glucose (BG) level was 301 ± 57 mg/dL in the SSI group (n = 28) and 219 ± 51 mg/dL in the BBI group (n = 12) (P <.001). The BBI regimen resulted in an average BG reduction of 52 ± 82 mg/dL throughout the course of dexamethasone therapy, while the SSI regimen produced an increase in the mean daily BG level of 128 ± 77 mg/dL (P <.001). On the last day of dexamethasone administration, the insulin requirement was 49 ± 29 units/day in the SSI group and 122 ± 39 units/day in the BBI group (P <.001). Three patients in the SSI group developed diabetic ketoacidosis or hyperosmolar hyperglycemia during steroid therapy. No hypoglycemia was observed in either group. The length of stay and infection rates were similar between groups.Conclusion Basal and bolus insulin regimen is an effective and safe approach for managing dexamethasone-induced hyperglycemia in hospitalized patients with hematologic malignancies.
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In the SSI group, the mean daily BGL was significantly higher (p<0.001).
“In the SSI group, the mean daily BGL was significantly higher (p<0.001), and the average insulin requirement was significantly lower (p<0.001).”
Gosmanov et al found more hyperglycaemic events in patients with type 2 DM under dexamethasone for 3 days (for a hematological malignancy) when treated with SSI therapy compared with a BBI therapy.
“Gosmanov et al 40 found more hyperglycaemic events in patients with type 2 DM under dexamethasone for 3 days (for a hematological malignancy) when treated with SSI therapy compared with a BBI therapy (table 2).”
One study compared glycaemic control of BBI regimen with SSI regimen.
“Another study compared glycaemic control of BBI regimen with SSI regimen.40”
In the SSI group, the average insulin requirement was significantly lower (p<0.001).
“In the SSI group, the mean daily BGL was significantly higher (p<0.001), and the average insulin requirement was significantly lower (p<0.001).”
3/28 (11%) persons treated with SSI were referred to an intensive care unit because of hyperglycaemic events.
“No hypoglycaemic events occurred in either groups, but 3/28 (11%) persons treated with SSI were referred to an intensive care unit because of hyperglycaemic events.”
No hypoglycaemic events occurred in either group.
“No hypoglycaemic events occurred in either groups, but 3/28 (11%) persons treated with SSI were referred to an intensive care unit because of hyperglycaemic events.”
In six studies, authors treated control groups with a basal-bolus insulin (BBI) regimen using insulin glargine as basal insulin, in one study with a BBI regimen using twice-daily insulin detemir, and one study using sliding-scale insulin (SSI) in addition to established DM medication.
“In six studies, authors treated control groups with a basal-bolus insulin (BBI) regimen using insulin glargine as basal insulin,33–36 38 39 in one study with a BBI regimen using twice-daily insulin detemir,40 and one study using sliding-scale insulin (SSI) in addition to established DM medication.37”
Gosmanov et al showed that basal-bolus insulin is better than sliding-scale insulin in terms of glycaemic control.
“Gosmanov et al 40 shows that BBI is better than SSI in terms of glycaemic control.”
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).”
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“Another study compared glycaemic control of BBI regimen with SSI regimen.(40) One study compared addition of SSI to routine DM medication with the addition of intermediate-acting insulin (IMI).”
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- Authors
- Aidar, R. G., Salil, G., Sundae, S., Limin, P., & Umpierrez, G. E.
- Affiliations
- Methodist University Hospital (US)
- Emory University (US)
- Venue
- Endocrine Practice
- Publisher
- Elsevier BV
- Published
- 2013-03
- Volume
- 19
- Issue
- 2
- Pages
- 231-235
- ISSN
- 1530-891X (ISSN-L)
- OpenAlex
- W1990469566
- Cited by
- 59
- References
- 16
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 5 · 2023: 2 · 2022: 5 · 2021: 8 · 2020: 2 · 2019: 5 · 2018: 5 · 2017: 2 · 2016: 10 · 2015: 5 · 2014: 5 · 2013: 1
- FWCI
- 5.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Endocrine Practice (publishedVersion)
- PubMed (publishedVersion)
- 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, diabetes mellitus, hematologic malignancies, dexamethasone, multiple daily insulin injections, sliding scale insulin, insulin regimens, detemir, insulin aspart, steroid-induced hyperglycemia, diabetic ketoacidosis, hospitalized patients
- MeSH terms
- Insulin Detemir, Aged, Dexamethasone, Diabetes Mellitus, Type 2, Drug Administration Schedule, Female, Glucocorticoids, Humans, Hyperglycemia, Hypoglycemic Agents, Insulin, Male, Middle Aged, Obesity, Pilot Projects, Retrospective Studies, Body Mass Index, Drug Monitoring, Antineoplastic Agents, Hormonal, Hematologic Neoplasms, Insulin, Long-Acting, Insulin Aspart, Insulin, Regular, Human
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