E-Poster Presentation ESA-SRB-ANZBMS 2021

A mixed insulin regimen can address glucocorticoid-induced hyperglycaemia (#351)

Gemma Scholes 1 , Elisabeth Ng 2 , Leon Bach 2 3 , Shoshana Sztal-Mazer 2 4
  1. Department of Medicine, Alfred Health, Melbourne, Victoria, Australia
  2. Department of Endocrinology & Diabetes, Alfred Health, Melbourne, Australia
  3. Department of Medicine, Monash University, Clayton, Victoria, Australia
  4. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

Aim: Prednisolone is widely used for its anti-inflammatory and immunosuppressive properties, but is frequently accompanied by hyperglycaemia. There are limited data to guide selection of an insulin regimen for treatment of glucocorticoid-induced hyperglycaemia (GIH), and data are specifically lacking on the use of mixed insulin in GIH. We hypothesised that mixed insulin (NovoMix30®) for GIH as a daily (mane) or twice-daily (mane + midi) regimen would provide effective glycaemic control while minimising nocturnal hypoglycaemia.

Methods: We performed a retrospective analysis of adult inpatients at a tertiary centre who were co-prescribed prednisolone ≥7.5mg mane and NovoMix30® mane +/- midi for >48 hours from November 2018 to June 2020. Blood glucose levels (BGLs) were retrieved for 54 patients across four days, beginning from the day before insulin commencement (day 0). A subgroup (n=37) received methylprednisolone ≥ 48 hours before oral prednisolone commencement. The expectation-maximisation algorithm was used to impute missing BGL values (30.7%) and repeated measures analysis was used to compare BGLs across days and between subgroups.

Results: The prednisolone-only subgroup had higher mean HbA1c (p<0.0001), initial prednisolone dose (p<0.05) and BGLs across all time windows (p<0.001). There was no significant interaction of steroid type with time of day or days of treatment, so results were pooled. NovoMix30® significantly decreased glucose levels in the morning (p=0.001) and afternoon (p=0.019) without an effect on fasting or evening levels (Figure 1). However, glycaemic control was suboptimal overall with insulin doses of ≤0.22 U/kg and insulin/prednisolone ratios of ≤0.39 U/mg. One hypoglycaemic event (BGL 3.7 mmol/L) occurred among 69 BGLs recorded from midnight to fasting.

Conclusion: Although limited by its retrospective nature and incomplete BGL data, this study demonstrates that mixed insulin mane +/- midi targets the glucose profile seen with GIH, however higher doses are required.

 

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