Vidler Jennifer, Rogers Charlotte, Yallop Deborah, Devereux Stephen, Wellving Ellinor, Stewart Orla, Cox Alison, Hunt Katharine F, Kassam Shireen
Department of Haematology, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
Department of Diabetes, King's College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
J Clin Transl Endocrinol. 2017 Jun 24;9:18-20. doi: 10.1016/j.jcte.2017.06.003. eCollection 2017 Sep.
High dose steroids (HDS) are used in the treatment of haematological malignancies. The reported risk of steroid-induced diabetes (SID) is high. However, screening is not consistently performed. We implemented a protocol for detection and management of SID and steroid-induced hyperglycamia (SIH) in haematology outpatients receiving HDS. Eighty-three people were diagnosed with a lymphoproliferative disorder, of whom 6 had known Type 2 diabetes. Fifty-three people without known diabetes were screened by HbA1c and random venous plasma glucose. All patients (n = 34) subsequently prescribed HDS checked capillary blood glucose (CBG) pre-breakfast and pre-evening meal. Treatment algorithms used initiation and/or dose titration of gliclazide or human NPH insulin, aiming for pre-meal CBG 5-11 mmol/l. Type 2 diabetes was identified in 4/53 people screened (7.5%). Of 34 people treated with HDS, 17 (44%) developed SIH/SID. All 7 people with Type 2 diabetes developed SIH and 3 required insulin. Of 27 people without known diabetes, 8 (30%) developed SID and 1 required insulin. Pre-treatment HbA1c was higher in people who developed SID compared to those that did not (p = 0.002). This is the first report of a SID/SIH detection and treatment protocol for use in people with lymphoproliferative disorders receiving intermittent HDS, demonstrating its feasibility and safety.
大剂量类固醇（HDS）用于治疗血液系统恶性肿瘤。据报道，类固醇诱导的糖尿病（SID）风险很高。然而，筛查并未始终如一地进行。我们实施了一项针对接受HDS的血液科门诊患者的SID和类固醇诱导的高血糖症（SIH）的检测和管理方案。83人被诊断患有淋巴增殖性疾病，其中6人患有2型糖尿病。对53名无已知糖尿病的患者进行了糖化血红蛋白（HbA1c）和随机静脉血浆葡萄糖筛查。所有随后开具HDS的患者（n = 34）均在早餐前和晚餐前检查毛细血管血糖（CBG）。治疗算法采用格列齐特或人低精蛋白胰岛素（NPH）起始和/或剂量滴定，目标是使餐前CBG为5-11 mmol/L。在筛查的53人中，有4人（7.5%）被确诊为2型糖尿病。在接受HDS治疗的34人中，17人（44%）出现了SIH/SID。所有7名2型糖尿病患者均出现了SIH，其中3人需要胰岛素治疗。在27名无已知糖尿病的患者中，8人（30%）出现了SID，1人需要胰岛素治疗。与未出现SID的患者相比，出现SID的患者治疗前HbA1c更高（p = 0.002）。这是首篇关于用于接受间歇性HDS的淋巴增殖性疾病患者的SID/SIH检测和治疗方案的报告，证明了其可行性和安全性。
