Department of Diabetes & Endocrinology, Westmead Hospital, Westmead, NSW, Australia.
Diabetes Res Clin Pract. 2013 Mar;99(3):277-80. doi: 10.1016/j.diabres.2012.12.023. Epub 2013 Jan 5.
The objective of this study was to systematically evaluate the incidence of steroid-induced hyperglycaemia in a tertiary referral hospital. We conducted a glucometric audit of a prospective protocol where glucose monitoring was routinely performed on patients treated with high-dose steroids.
The protocol specified routine fingerprick glucose monitoring for patients commencing high-dose steroid therapy (prednisone 25mg/day, dexamethasone 4 mg/day, hydrocortisone 100mg/day, or more) for a minimum of 48 h. The medical records and charts of these patients were audited after a 6 month period.
There were 80 non-diabetic patients treated with high-dose steroids and 862 blood glucose (BG) readings were recorded. The mean BG was ≥8 mmol/L in 38 (48%) patients and ≥10 mmol/L in 11 (14%) subjects. Sixty-nine (86%) subjects had at least one BG ≥8 mmol/L, and 56 (70%) subjects had at least one BG ≥10 mmol/L. Among those with hyperglycaemia, it had developed within 48 h in 94% of subjects. When prednisone was administered as a once daily morning dose, glucose levels peaked in the afternoon, and would return to baseline by the next morning.
We conclude that steroid-induced hyperglycaemia is common in hospital. Patients should be monitored for hyperglycaemia upon commencement of high-dose steroid therapy and treatment commenced as indicated.
本研究旨在系统评估一家三级转诊医院中皮质类固醇诱导性高血糖的发生率。我们对一项前瞻性方案进行了血糖监测审核，该方案规定对接受大剂量皮质类固醇治疗的患者常规进行血糖监测。
该方案规定，对起始接受高剂量类固醇治疗（泼尼松 25mg/天、地塞米松 4mg/天、氢化可的松 100mg/天或更高剂量）的患者，至少进行 48 小时的常规指尖血糖监测。在 6 个月后审核这些患者的病历和图表。
有 80 例非糖尿病患者接受了大剂量类固醇治疗，共记录了 862 次血糖（BG）读数。38 例（48%）患者的平均 BG≥8mmol/L，11 例（14%）患者的平均 BG≥10mmol/L。69 例（86%）患者至少有一次 BG≥8mmol/L，56 例（70%）患者至少有一次 BG≥10mmol/L。在出现高血糖的患者中，94%的患者在 48 小时内出现高血糖。当泼尼松作为每日一次的晨服剂量给药时，血糖水平在下午达到峰值，到次日早晨恢复到基线水平。
我们的结论是，皮质类固醇诱导性高血糖在医院中很常见。患者在开始接受大剂量皮质类固醇治疗时应监测高血糖，并根据需要开始治疗。
