title: Continuous monitoring of circadian glycemic patterns in patients receiving prednisolone for COPD.
abstract: BACKGROUND
  Endogenous glucocorticoid excess (Cushing's syndrome) predominantly increases postprandial glucose concentration. The pattern of hyperglycemia induced by prednisolone has not been well characterized.
  
  
  OBJECTIVE
  Our objective was to define the circadian effect of prednisolone on glucose concentration to optimize management of prednisolone-induced hyperglycemia.
  
  
  METHODS
  This was a cross-sectional study in a teaching hospital.
  
  
  METHODS
  Participants included 60 consecutive consenting subjects with chronic obstructive pulmonary disease admitted to hospital: 13 without known diabetes admitted for other indications and not treated with glucocorticoids (group 1), 40 without known diabetes admitted with an exacerbation of chronic obstructive pulmonary disease and treated with prednisolone (group 2, prednisolone = 30 ± 6 mg/d), and seven with known diabetes treated with prednisolone (group 3, prednisolone = 26 ± 9 mg/d).
  
  
  METHODS
  Interstitial glucose concentration was assessed during continuous glucose monitoring.
  
  
  RESULTS
  Significantly more subjects in group 2 [21 of 40 (53%), P = 0.02] and group 3 [seven of seven (100%), P = 0.003] recorded a glucose of at least 200 mg/dl (≥11.1 mmol/liter) during continuous glucose monitoring than in group 1 [one of 13 (8%)]. The mean glucose concentration between 2400-1200 h for group 3 (142 ± 36 mg/dl) was significantly greater than in the other two groups (P < 0.005), whereas mean glucose concentrations between 2400-1200 h in group 1 (108 ± 16 mg/dl) and group 2 (112 ± 22 mg/dl) were not significantly different. In contrast, the mean glucose concentrations between 1200-2400 h for group 2 (142 ± 25 mg/dl) and group 3 (189 ± 32 mg/dl) were both significantly greater than group 1 (117 ± 14 mg/dl, P < 0.05 for both comparisons).
  
  
  CONCLUSIONS
  Prednisolone predominantly causes hyperglycemia in the afternoon and evening. Treatment of prednisolone-induced hyperglycemia should be targeted at this time period.
authors.affiliation: Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Daw Park, Adelaide 5041, Australia. morton.burt@health.sa.gov.au
authors.forename: Morton G
authors.initials: MG
authors.lastname: Burt
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Roberts
authors.forename: Norma R
authors.initials: NR
authors.lastname: Aguilar-Loza
authors.forename: Peter
authors.initials: P
authors.lastname: Frith
authors.forename: Stephen N
authors.initials: SN
authors.lastname: Stranks
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring; D003430:Cross-Sectional Studies; D005260:Female; D006442:Glycated Hemoglobin; D006801:Humans; D006943:Hyperglycemia / Q000097:blood*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019518:Postprandial Period; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood* / Q000188:drug therapy*
chemical_list: D000893:Anti-Inflammatory Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D011239:Prednisolone