Oral Virtual Presentation (Virtual only) ESA-SRB-ANZBMS 2021

Clinical factors affecting insulin dose requirements during treatment of prednisolone-induced hyperglycaemia (#136)

Angela Xun-Nan Chen 1 2 , Anjana Radhakutty 2 3 , Stephen Stranks 1 , Campbell Thompson 4 , Morton Burt 1 2
  1. Endocrinology, Flinders Medical Centre, Bedford Park, SA, Australia
  2. School of Medicine, Flinders University, Bedford Park, SA, Australia
  3. Endocrinology , Lyell McEwin Hospital, Elizabeth Vale, SA, Australia
  4. General Medicine, Royal Adelaide Hospital, Adelaide, SA, Australia

Background: Prednisolone is a semi-synthetic glucocorticoid hormone that commonly causes hyperglycaemia in hospitalised patients, which is associated with increased morbidity and mortality. Weight-based insulin regimens are recommended to treat prednisolone-induced hyperglycaemia, but many patients remain hyperglycaemic due to wide variability in insulin dose requirements.1 To inform insulin dosing, we investigated which clinical characteristics are associated with daily insulin requirements in patients prescribed prednisolone.

Methods: In this prospective study, 50 adult medical inpatients with an acute inflammatory illness and prescribed a morning dose of prednisolone ≥20 mg/day with hyperglycaemia (one finger-prick blood glucose level (BGL) >15 mmol/L or two BGL >10 mmol/L within 24 hours) received an intravenous Actrapid insulin infusion for 24 hours to determine their daily insulin requirements. Hourly flash glucose monitoring was performed with Freestyle Libre Device (Abbott). The daily insulin dose required to attain an average flash glucose concentration of 8.0 mmol/L was calculated. Associations between clinical variables and daily insulin dose were examined using linear regression.

Results: The participants age was 69 ± 10 years, prednisolone dose was 34 ± 10 mg, HbA1c was 7.7 ± 2.0%, 77% had known type 2 diabetes and 30% were female. In univariate analysis, weight was weakly but significantly associated with daily insulin dose (Table). Other variables associated with daily insulin dose were HbA1c, sex, prior diabetes treatment and peak glucose before commencing insulin; prednisolone dose was not. In multivariate analysis HbA1c, weight, sex, diabetes treatment and diabetes status were independently associated with daily insulin dose (R2 = 0.65, p<0.001).

Conclusions: Combining HbA1c, sex, diabetes status, diabetes treatment and weight explains an additional 54% of the variability in daily insulin dose in patients with hyperglycaemia while prescribed prednisolone, compared to weight alone. Incorporation of these additional clinical characteristics into individualised insulin algorithms will refine insulin dosing for prednisolone-induced hyperglycaemia.

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  1. 1. Radhakutty, A., Stranks, J.L., Mangelsdorf, B.L., Drake, S.M., Roberts, G.W., Zimmermann, A.T., Stranks, S.N., Thompson, C.H. and Burt, M.G., 2017. Treatment of prednisolone‐induced hyperglycaemia in hospitalized patients: I nsights from a randomized, controlled study. Diabetes, Obesity and Metabolism, 19(4), pp.571-578.