Identification of subjects with glucocorticoid-induced hyperglycaemia while on high dose glucocorticoids as part of chemotherapy protocol - Cross Sectional study (#229)
Glucocorticoids are employed as as part of various anti-cancer therapy protocols. Glucocorticoids have a variety of actions that lead to hyperglycemia or an exacerbation of pre-existing diabetes.
Patients with diabetes mellitus or glucose intolerance exhibit higher blood glucose levels while taking glucocorticoids. In addition, new-onset hyperglycemia or, rarely, a non-ketotic hyperosmolar state or diabetic ketoacidosis develop without warning in patients with early subclinical diabetes or glucose intolerance [5,7, 8].
Hyperglycaemia increases length of stay in hospitalised patients by putting patients at higher risk of complications, and adverse outcomes [12, 13].
Investigation of prevalence of glucocorticoid induced impaired glycaemic control, and analysis of the relation of predictive history/physical exam and development of hyperglycaemia (BGL>11.1mmol/L) and dysglycaemia ( BGL>7.8mmol/L) .
53 Nondiabetic patients in oncology ward, Box Hill Hospital on high dose steroids* as part of anti-cancer therapy protocol were studied over 5 months period. Patients were screened for history/physical exam identifiable risk factors and blood glucose levels were monitored daily at 4pm for 2-5 consecutive days while receiving steroids.
*High dose steroid identified as Prednisolone ≥ 10mg, and any dose of Dexamethasone.
BGL rise was observed in significant number of patients studied (15% BGL≥11.1mmol/L, and 71.60% BGL ≥ 7.8mmol/L).
Average BGL was higher by 1.25mmol/L in patients receiving corticosteroid doses ≥ 400mg of Hydrocortisone (P value=0.039); however there was no statistically significant linear relation between corticosteroid dose, and BGL level.
Average BGL was also higher in patients with BMI≥25 by 1.42mmol/L (P value=0.038),and there was a significant relation between BMI and hyperglycamia (R2 = 0.12, Pvalue=0.018).
As prevalence of hyperglycamia was significant, routine monitoring of blood glucose level in patients receiving high dose glucocorticoids with anti cancer treatment seems required, and patients with BMI≥ 25 and higher doses of steroids are at increased risk.
- Schäcke, H, Döcke, WD, Asadullah, K. Mechanisms involved in the side effects of glucocorticoids. Pharmacol Ther 2002; 96:23.
- McMahon, M, Gerich, J, Rizza, R. Effects of glucocorticoids on carbohydrate metabolism. Diabetes Metab Rev 1988; 4:17.
- Shamoon, H, Soman, V, Sherwin, RS. The influence of acute physiological increments of cortisol on fuel metabolism and insulin binding to monocytes in normal humans. J Clin Endocrinol Metab 1980; 50:495.
- Simmons, PS, Miles, JM, Gerich, JE, Haymond, MW. Increased proteolysis. An effect of increases in plasma cortisol within the physiologic range. J Clin Invest 1984; 73:412.
- Olefsky, JM, Kimmerling, G. Effects of glucocorticoids on carbohydrate metabolism. Am J Med Sci 1976; 271:202.
- Roma LP, Bosqueiro JR, Cunha DA, Carneiro EM, Gurgul-Convey E, Lenzen S, Boschero AC, Souza KL. Protection of insulin-producing cells against toxicity of dexamethasone by catalase overexpression. Free Radical Biology and Medicine 47 (2009) 1386-1393
- Gurwitz, JH, Bohn, RL, Glynn, RJ, et al. Glucocorticoids and the risk for initiation of hypoglycemic therapy. Arch Intern Med 1994; 154:97.
- Wolfe, F, Michaud, K. The risk of myocardial infarction and pharmacologic and nonpharmacologic myocardial infarction predictors in rheumatoid arthritis: a cohort and nested case-control analysis. Arthritis Rheum 2008; 58:2612.
- Shepherd, P.R., and B.B. Kahn. 1999. Glucose transporters and insulin action: Implications for insulin resistance and diabetes mellitus. NEJM. 41(4):248-257.
- Campbell RK. Etiology and effect on outcomes of hyperglycemia in hospitalized patients.Am J Health Syst Pharm. 2007 May 15;64(10 Suppl 6):S4-8. Review.
- Presutti E, Millo J. Controlling blood glucose levels to reduce infection. Crit Care Nurs Q. 2006 Apr-Jun;29(2):123-31.
- Clinical Practice Guideline: Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Setting: An Endocrine Society Clinical Practice Guideline JCEM 2012 97: 16-38.