title: Efficacy of a basal bolus insulin protocol to treat prednisolone-induced hyperglycaemia in hospitalised patients.
abstract: OBJECTIVE
  Few studies have specifically investigated treatment of prednisolone-induced hyperglycaemia.
  
  
  OBJECTIVE
  To determine if a basal bolus insulin (BBI) protocol for inpatient hyperglycaemia is effective in patients prescribed acute prednisolone for an inflammatory disease.
  
  
  METHODS
  In a cross-sectional study, 66 patients with type 2 diabetes admitted to a general medical ward and treated with BBI for up to 5 days were studied. Twenty-four patients were taking prednisolone ≥10 mg/day to treat an acute inflammatory disease. The remaining 42 patients were a control group. The primary outcome was mean daily blood glucose level.
  
  
  RESULTS
  There were no significant differences in glycosylated haemoglobin (8.1 ± 1.0 vs 8.1 ± 1.6%, P = 0.88), age (77 ± 11 vs 75 ± 14 years, P = 0.57), male sex (63 vs 60%, P = 0.81) or body mass index (30.0 ± 5.3 vs 30.2 ± 11.5 kg/m(2) , P = 0.90) between patients taking prednisolone and controls. Mean daily glucose concentration was higher in patients taking prednisolone than in controls (12.2 ± 0.3 vs 10.0 ± 0.1 mmol/L, P < 0.001). Blood glucose level was higher in patients on prednisolone at 1700 h (14.6 ± 0.6 vs 10.3 ± 0.3 mmol/L, P < 0.001) and 2100 h (14.5 ± 0.6 vs 10.5 ± 0.3 mmol/L, P < 0.001), with no significant differences at 0700 h and 1200 h. These findings occurred despite patients taking prednisolone receiving a higher daily insulin dose than controls (0.67-0.70 vs 0.61-0.65 U/kg, P = 0.001) because of higher doses of ultra-rapid-acting insulin at 1200 h and 1700 h.
  
  
  CONCLUSIONS
  Hospitalised patients taking prednisolone had substantial afternoon and evening hyperglycaemia despite receiving BBI via a protocol for inpatient hyperglycaemia. Specific insulin regimens for prednisolone-induced hyperglycaemia are needed that recommend more insulin during this time period.
authors.affiliation: Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, South Australia, Australia; Faculty of Health Sciences, Flinders University, Adelaide, South Australia, Australia.
authors.forename: M G
authors.initials: MG
authors.lastname: Burt
authors.forename: S M
authors.initials: SM
authors.lastname: Drake
authors.forename: N R
authors.initials: NR
authors.lastname: Aguilar-Loza
authors.forename: A
authors.initials: A
authors.lastname: Esterman
authors.forename: S N
authors.initials: SN
authors.lastname: Stranks
authors.forename: G W
authors.initials: GW
authors.lastname: Roberts
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D005938:Glucocorticoids; D007004:Hypoglycemic Agents; D007328:Insulin; D011239:Prednisolone
keywords: circadian rhythm; glucocorticoid; hospitalised patient; hyperglycaemia; insulin therapy