Identification of subjects with glucocorticoid-induced hyperglycaemia while on high dose glucocorticoids as part of chemotherapy protocol - Cross Sectional study — ASN Events
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Identification of subjects with glucocorticoid-induced hyperglycaemia while on high dose glucocorticoids as part of chemotherapy protocol - Cross Sectional study (#229)

Soulmaz Shorakae 1 , Michelle Gribble 1 , Christopher Gilfillan 1
  1. Endocrinology, Eastern Health, Melbourne, Australia

Background

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].

Study Goal

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) [14].

Methods

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.

Results

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).

Conclusion

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.

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