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Glucocorticoids, also known as steroids, are a class of anti-inflammatory drugs utilised widely in clinical practice for a variety of conditions. They are associated with a range of side effects including abnormalities of glucose metabolism. Multiple guidelines have been published to illustrate best management of glucocorticoid-induced hyperglycaem...
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... commencing insulin therapy. Once daily intermediateacting insulin in the morning is recommended initially but twice daily or basal bolus regimens can be considered to achieve glucose targets. In those already on insulin therapy, doses can be titrated up by 10-20% to achieve targets and evening basal doses can be transferred to the morning (Figs. 3, ...
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The American Diabetes Association (ADA) “Standards of Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional exper...
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... Several studies have been conducted to identify risk factors for GIH, as shown in Table 1. Notable risk factors include the type, route, dosage, and regimen of glucocorticoid administration, previous GIH events, impaired fasting glucose or glucose tolerance, elevated glycated hemoglobin (HbA1c), a family history of diabetes, advanced age, obesity, a low estimated glomerular filtration rate, and the concurrent use of immunosuppressants [9,67]. In patients hospitalized with rheumatic or renal disease without diabetes, presence of one or more of these three risk factors-defined as older age (≥65 years), higher HbA1c (≥ 6.0%), or estimated glomerular filtration rate (<40 mL/min/ 1.73 m 2 )-more than doubled the risk of developing GIH [68]. ...
... Metabolic deterioration associated with insulin resistance, including obesity, hyperlipidemia, and a history of hyperglycemia, should be assessed, as these factors predispose individuals to the development of GIH [9]. Furthermore, patients at high-risk should be thoroughly questioned about their diabetes history, and HbA1c levels should be tested before initiating glucocorticoid therapy to exclude undiagnosed diabetes [67]. It is important to recognize that HbA1c has diagnostic limitations due to factors that alter red blood cell lifespan [74]. ...
Glucocorticoids provide a potent therapeutic response and are widely used to treat a variety of diseases, including coronavirus disease 2019 (COVID-19) infection. However, the issue of glucocorticoid-induced hyperglycemia (GIH), which is observed in over one-third of patients treated with glucocorticoids, is often neglected. To improve the clinical course and prognosis of diseases that necessitate glucocorticoid therapy, proper management of GIH is essential. The key pathophysiology of GIH includes systemic insulin resistance, which exacerbates hepatic steatosis and visceral obesity, as well as proteolysis and lipolysis of muscle and adipose tissue, coupled with β-cell dysfunction. For patients on glucocorticoid therapy, risk stratification should be conducted through a detailed baseline evaluation, and frequent glucose monitoring is recommended to detect the onset of GIH, particularly in high-risk individuals. Patients with confirmed GIH who require treatment should follow an insulin-centered regimen that varies depending on whether they are inpatients or outpatients, as well as the type and dosage of glucocorticoid used. The ideal strategy to maintain normoglycemia while preventing hypoglycemia is to combine basal-bolus insulin and correction doses with a continuous glucose monitoring system. This review focuses on the current understanding and latest evidence concerning GIH, incorporating insights gained from the COVID-19 pandemic.
... The type of glucocorticoid and duration of action must be considered in determining insulin treatment regimens. For individuals who are on higher doses of glucocorticoids, an increase in the dosage of prandial and correctional insulin may be needed in addition to basal insulin [93]. The dose of correctional insulin is based on the dose of the administered glucocorticoid and the weight of the person [94]. ...
... General anaesthesia with intravenously administered anaesthetics exert a more profound impact on glucose metabolism compared to epidural anaesthesia with epidurally administered medication [42], and general anaesthesia with volatile anaesthetics having a more profound impact than total intravenous anaesthetics [43]. Furthermore, certain other types of medications, such as corticosteroids, can also induce hyperglycaemia [44]. The administration of substantial amounts of glucose through intravenous administration or enteral feeding can further contribute to hyperglycaemia [9]. ...
Traumatic brain injury (TBI) is a major public health concern with significant consequences across various domains. Following the primary event, secondary injuries compound the outcome after TBI, with disrupted glucose metabolism emerging as a relevant factor. This narrative review summarises the existing literature on post-TBI alterations in glucose metabolism. After TBI, the brain undergoes dynamic changes in brain glucose transport, including alterations in glucose transporters and kinetics, and disruptions in the blood–brain barrier (BBB). In addition, cerebral glucose metabolism transitions from a phase of hyperglycolysis to hypometabolism, with upregulation of alternative pathways of glycolysis. Future research should further explore optimal, and possibly personalised, glycaemic control targets in TBI patients, with GLP-1 analogues as promising therapeutic candidates. Furthermore, a more fundamental understanding of alterations in the activation of various pathways, such as the polyol and lactate pathway, could hold the key to improving outcomes following TBI.
... OGTT and glycated hemoglobin are not indicated for monitoring and screening patients who develop hyperglycemia induced by acute diabetes, unless otherwise indicated (Barker et al., 2023). The glycated hemoglobin test is of great importance before starting treatment in patients with a high chance of developing hyperglycemia and to exclude pre-existing diabetes (Barker et al., 2023;Nakamura et al., 2020;). ...
... OGTT and glycated hemoglobin are not indicated for monitoring and screening patients who develop hyperglycemia induced by acute diabetes, unless otherwise indicated (Barker et al., 2023). The glycated hemoglobin test is of great importance before starting treatment in patients with a high chance of developing hyperglycemia and to exclude pre-existing diabetes (Barker et al., 2023;Nakamura et al., 2020;). Diabetic patients must check their blood glucose 4 times a day, whereas non-diabetics are recommended to check their blood glucose only once, unless their blood glucose levels are above 200mg/dL, thus changing the indication to 4 daily measurements. ...
... A blood glucose target between 108 mg/dL and 180 mg/dL is recommended for hospitalized patients. In groups at high risk of hypoglycemia or vulnerable to harm from hypoglycemia, milder glycemic targets can be used, aiming for levels between 108mg/dL and 270mg/dL (Aberer et al., 2021;Barker et al., 2023;Litty et al., 2017). ...
Glucocorticoids are medications of wide medical use, notably due to their known anti-inflammatory effects. Furthermore, fluctuations in glycemic indexes stand out as risk factors for clinical and surgical complications, mortality and increased hospital stay. The study consists of an integrative and descriptive literature review, through the PUBMED platform with the following keywords: “Hyperglycemia”, “Glucocorticoid” and “Induce”, in the last 12 years and aims to gather and unify information regarding the understanding and clinical and therapeutic management of hyperglycemia induced by the use of corticosteroids and corticogenic diabetes. The fluctuation in glycemic indexes with the use of corticosteroid therapy is an imbalance between the increase in insulin resistance and the inhibition of insulin production and secretion at the pancreatic cellular level. Screening for Diabetes Mellitus in patients on corticosteroid therapy is based on consensus in the literature with a plasma glucose level above 125 mg/dL, any capillary measurement above 200 mg/dL, HbA1c> 6.5% or oral tolerance test glucose above 200mg/dL after 2 hours. The main glycemic target is capillary blood glucose between 108-180 mg/dL and in cases of initiating therapeutic approaches for hospital management of glycemic fluctuations, the use of insulin therapy is chosen. Hyperglycemia induced by the use of corticosteroids is a topic that has been gaining prominence in the medical scenario, despite the lack of studies that uniformly protocol the approach to patients when this scenario is confirmed, with the aim of reducing the risks associated with hospitalization.
