Screening for Steroid-Induced Hyperglycaemia in Hospital and Barriers to its Detection and Management

Abstract

Background This thesis examines the detection and management of steroid-induced hyperglycaemia in hospitalised patients, and physicians’ and nurses’ perceived barriers to identifying and treating this condition. This study arises from the current lack of reports on the prevalence and management of this condition in New Zealand hospitals, despite international evidence reporting this condition is common in hospital. In addition, no New Zealand reports, and only one international report, were found on the barriers to managing steroid-induced hyperglycaemia, signifying a gap in current knowledge. Aims  To identify features of steroid administration and to examine the rates of glycaemic monitoring for patients administered steroids.  To examine how hyperglycaemia during steroid therapy is currently managed.  To explore doctors’ and nurses’ perceived barriers to the effective detection and management of steroid-induced hyperglycaemia. Methods An audit of medical files of patients admitted to the three general medical wards in a mid-sized New Zealand hospital was undertaken to identify patients administered steroids on six randomly selected days over a six-week period between June and July, 2015. Following this audit, a self-administered survey was developed to collect information from physicians and nurses working on the medical wards during the study period. Respondents were asked to identify and rank barriers to the detection and management of steroid-induced hyperglycaemia that had been identified in the literature. Results The records of 397 patients were audited. Steroids were administered to 64 (16%) patients, however only 11 (17%) had their blood glucose levels monitored. All patients previously diagnosed with type 2 diabetes (n=8) and administered steroids underwent glycaemic monitoring compared with only 5% of patients (n=3) without diagnosed diabetes (p<0.001). Of those, over half (55%) of patients with diabetes, and one third of patients without diabetes had hyperglycaemia detected during steroid therapy. Seventeen physicians, including two medical students (74%), and 45 (60%) nurses completed the survey, giving a combined response rate of 63%. The most common barriers to effectively detecting and managing steroid-induced hyperglycaemia were the lack of clinical guidelines reported by the majority of physicians (65%) and nurses (77%), and insufficient knowledge of insulins, also reported by most physicians (69%) and nurses (72%). Conclusions The proportion of patients without diabetes screened for steroid-induced hyperglycaemia was very low despite the reported high incidence of hyperglycaemia in patients administered steroids. These findings suggest that clinical guidelines and improved knowledge of insulins to treat steroid-induced hyperglycaemia may improve its detection and management.