title: Treatment of prednisolone-induced hyperglycaemia in hospitalized patients: Insights from a randomized, controlled study.
abstract: Prednisolone causes hyperglycaemia predominantly between midday and midnight. Consequently, glargine-based basal-bolus insulin regimens may under treat daytime hyperglycaemia and cause nocturnal hypoglycaemia. We investigated whether an isophane-based insulin regimen is safer and more effective than a glargine-based regimen in hospitalized patients.
  
  
  
  Fifty inpatients prescribed ≥20 mg/day prednisolone acutely with (1) finger prick blood glucose level (BGL) ≥15 mmol/L or (2) BGLs ≥10 mmol/L within the previous 24 hours were randomized to either insulin isophane or glargine before breakfast and insulin aspart before meals. The initial daily insulin dose was 0.5 U/kg bodyweight or 130% of the current daily insulin dose. Glycaemic control was assessed using a continuous glucose monitoring system.
  
  
  
  On Day 1, there were no significant differences in percentage of time outside a target glucose range of 4 to 10 mmol/L (41.3% ± 5.5% vs 50.0% ± 5.7%, P  = .28), mean daily glucose (10.2 ± 0.7 vs 10.8 ± 0.8 mmol/L, P  = .57) or glucose <4 mmol/L (2.2% ± 1.1% vs 2.0% ± 1.3%, P  = .92) in patients randomized to isophane and glargine. In patients treated for 3 days, the prednisolone dose was reduced ( P  = .02) and the insulin dose was increased over time ( P  = .02), but the percentage of time outside the 4 to 10 mmol/L glucose range did not differ over time ( P  = .45) or between groups ( P  = .24).
  
  
  
  There were no differences in the efficacy or safety of the isophane and glargine-based insulin regimens. We recommend an initial daily insulin dose of 0.5 units/kg bodyweight if not on insulin, a greater than 30% increase in pre-prednisolone insulin dose and larger insulin dose adjustments in patients with prednisolone-induced hyperglycaemia.
authors.affiliation: School of Medicine, Flinders University, Adelaide, Australia.|Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, Australia.|Department of Diabetes and Endocrinology, Lyell Mc Ewin Hospital, Adelaide, Australia.
authors.forename: Anjana
authors.initials: A
authors.lastname: Radhakutty
authors.affiliation: Department of Diabetes and Endocrinology, Lyell Mc Ewin Hospital, Adelaide, Australia.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Stranks
authors.affiliation: Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, Australia.
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Mangelsdorf
authors.affiliation: Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, Australia.
authors.forename: Sophie M
authors.initials: SM
authors.lastname: Drake
authors.affiliation: Pharmacy Department, Flinders Medical Centre, Adelaide, Australia.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Roberts
authors.affiliation: Department of Diabetes and Endocrinology, Lyell Mc Ewin Hospital, Adelaide, Australia.
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Zimmermann
authors.affiliation: Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, Australia.
authors.forename: Stephen N
authors.initials: SN
authors.lastname: Stranks
authors.affiliation: School of Medicine, Flinders University, Adelaide, Australia.|Discipline of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Campbell H
authors.initials: CH
authors.lastname: Thompson
authors.affiliation: School of Medicine, Flinders University, Adelaide, Australia.|Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, Australia.
authors.forename: Morton G
authors.identifier: 0000-0001-6468-7727
authors.initials: MG
authors.lastname: Burt
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D004334:Drug Administration Schedule; D005260:Female; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000188:drug therapy*; D007003:Hypoglycemia / Q000139:chemically induced; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007297:Inpatients; D007328:Insulin / Q000008:administration & dosage; D061267:Insulin Aspart / Q000008:administration & dosage; D000069036:Insulin Glargine / Q000008:administration & dosage*; D007336:Insulin, Isophane / Q000008:administration & dosage*; D008297:Male; D062407:Meals; D008875:Middle Aged; D011239:Prednisolone / Q000009:adverse effects*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D000069036:Insulin Glargine; D007336:Insulin, Isophane; D011239:Prednisolone; D061267:Insulin Aspart
keywords: basal insulin; continuous glucose monitoring (CGM); endocrine therapy; glycaemic control; hypoglycaemia; randomized trial