title: Corticosteroid-induced diabetes in palliative care.
abstract: BACKGROUND
  Corticosteroids are one of the most commonly used medications in palliative care. Although the benefit of corticosteroids generally outweighs the risk in the palliative population, side effects are common and necessitate careful consideration prior to prescribing. In March of 2010, a guideline for monitoring blood glucose values was implemented as part of our standard care within our two inpatient tertiary palliative care units.
  
  
  METHODS
  A retrospective study was conducted, the aim of which was twofold. First, we hoped to determine a prevalence rate for steroid-induced diabetes mellitus (SDM) in palliative care and whether or not screening glucose levels twice weekly was appropriate or required. Second, we wanted to determine if possible predictors existed for the development of SDM in a palliative population, thereby identifying the patients most at risk who would benefit from ongoing glucose monitoring.
  
  
  CONCLUSIONS
  We found that SDM is more common in palliative care patients than previously thought. Our study showed a higher likelihood of developing hyperglycaemia with higher doses of dexamethasone. But although dose is correlated with hyperglycemia, patients without high doses were also at risk. Further study is currently underway with slight modifications to the guideline to more accurately assess the physical burden, as well as the emotional and financial cost of a hyperglycemia screening protocol.
authors.affiliation: Program of Palliative Care, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada. JPILKEY@wrha.mb.ca
authors.forename: Jana
authors.initials: J
authors.lastname: Pilkey
authors.forename: Lisa
authors.initials: L
authors.lastname: Streeter
authors.forename: Alexandra
authors.initials: A
authors.lastname: Beel
authors.forename: Timothy
authors.initials: T
authors.lastname: Hiebert
authors.forename: Xuan
authors.initials: X
authors.lastname: Li
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects*; D000368:Aged; D000369:Aged, 80 and over; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care
chemical_list: D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids; D003907:Dexamethasone