The detection and management of steroid-induced hyperglycaemia in hospital and barriers to its effective management

Abstract

The detection and management of steroid-induced hyperglycaemia and barriers to its effective Management Miranda McDonald-Brown1, Robyn Dixon2 Barbara Daly3, 1Tauranga Hospital, Bay of Plenty District Health Board, Tauranga Hospital, 2Faculty of Medical and Health Science, The University of Auckland BACKGROUND • Glucocorticoids (steroids) are the leading cause of treatment-induced hyperglycaemia.1 • Steroid-induced hyperglycaemia in hospital setting is relatively common,1 however there is a lack of data on its prevalence and management in New Zealand. • Steroids are associated with new-onset hyperglycaemia in approximately a third of patients without diabetes.2 • International guidelines suggest all patients undergoing steroid therapy in hospital should undergo glycaemic monitoring.3,4,5,6 AIMS • To audit and document the rates of glycaemic monitoring for patients administered steroids, and the incidence and management of steroid-induced hyperglycaemia in a hospital setting. • To survey and identify doctors’ and nurses’ self-reported barriers to its detection and management. METHODS • An audit of patients on three general medical wards in a mid-sized NZ hospital, to identify patients administered steroids, on six randomly selected days over a six-week period between June and July, 2015. • A self-administered questionnaire administered to doctors and nurses working on the three medical wards during the study period. RESULTS • Of the 397 patients audited, steroids were administered to 64 (16%) patients, including 38 (59%) patients administered high dose steroids (≥ 40mg prednisone or equivalent). • Only 11 (17%) patients administered steroids had their blood glucose levels (BGLs) monitored. • All patients with type 2 diabetes (n=8) administered steroids were monitored compared with only 5% of patients (n=3) without diagnosed diabetes (p<0.001). • Six (55%) patients had elevated BGLs. Data on hyperglycaemic management of patients administered steroids was limited due to the low number of patients who underwent BGL monitoring. • For the survey, a combined response rate of 63% was achieved, 71% for doctors (n=15) and 60% for nurses (n=45), The most common barriers for detecting and managing steroid-induced hyperglycaemia were the lack of clinical guidelines and insufficient knowledge of insulins. • All 15 doctors (100%) and 37 nurses (82%) reported the provision of a guideline would improve the detection and management of steroid-induced hyperglycaemia. RECOMMENDATIONS • All patients administered steroids should undergo BGL monitoring regardless of their diabetes status. Clinical guideline development and improved knowledge of insulins to treat steroid-induced hyperglycaemia may improve its detection and management.