Background and importance Glucocorticoid induced hyperglycaemia (GIH) is a common and underdiagnosed condition in the hospital emergency department (ED) that leads to increased hospital stay and a worsening prognosis.
Aim and objectives To determine the cumulative incidence of the development of GIH in non-diabetic patients treated with systemic glucocorticoids (SG) in the ED, and to study the associated risk factors. Secondary objectives were to determine the mean time to develop GIH, as well as compliance with the general recommendations of scientific societies for its therapeutic management.
Material and methods This was a prospective descriptive study. Non-diabetic patients who started SG in the ED were included. Data were collected over 3 months: age, obesity, family history of diabetes, type of glucocorticoid and accumulated dose, equivalence to hydrocortisone, and received prior to GIH or within 72 hours if the event did not occur. Hyperglycaemia was defined as preprandial and postprandial capillary glucose ≥140 and ≥180 mg/dL, respectively. Recommendations were defined as periodic monitoring of capillary blood glucose for 72 hours or less if the patient was discharged. In the case of patients who initially were not monitored for glucose, this was indicated by the pharmacist. Patients without glycaemia data were excluded.
The χ2 test or Fisher’s exact test was applied for categorical variables and the Mann–Whitney U test for quantitative variables. Time from SG initiation to GIH was measured using the Kaplan–Meier test. SPSS V15.0 programme was used to analyses the data.
Results A total of 32 patients (53.13% men) were included, with a mean age of 72±17.6 years, 28.12% were obese patients and 96.87% had no family history of diabetes. Most patients (90.7%) were treated with intermediate acting glucocorticoids and mean accumulated dose of hydrocortisone received was 468.13±276 mg. GIH cumulative incidence was 53.12% in 72 hours. No risk factor showed a statistically significant difference related to the development of GIH. Mean time to develop GIH was 46.15 hours (95% CI 36.1 to 56.1). Older patients had a higher risk of developing GIH than younger patients (HR=1.05; 95% CI 1 to 1.1; p=0.047). Regarding compliance and recommendations, only 21.87% of patients were initially monitored for glucose.
Conclusion and relevance Data obtained showed a high GIH cumulative incidence (53.12%) and no risk factor was associated with GIH, probably because of the size of the sample. However, the risk of developing early GIH increased with age. The low rate of compliance with the recommendations confirms the importance of implementing an easily applicable protocol that minimises this situation, especially in older patients.
Conflict of interest No conflict of interest
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