University Clinic of Respiratory and Allergic Diseases Golnik, Golnik 36, 4204, Golnik, Slovenia.
Centre for Clinical Toxicology and Pharmacology, University Medical Centre Ljubljana, Zaloška 7, 1000, Ljubljana, Slovenia.
Pharmacol Rep. 2021 Jun;73(3):796-805. doi: 10.1007/s43440-021-00234-2. Epub 2021 Mar 2.
The aim of this study was to determine the incidence of steroid-induced hyperglycaemia (SIH) in patients hospitalised at the tertiary centre for lung diseases, to assess glycaemic control during hospitalisation, and to determine the factors associated with the control of SIH.
A 4-month retrospective study was conducted. All patients who received systemic glucocorticoids for ≥ 2 days during hospitalisation, with ≥ 2 elevated blood glucose (BG) readings, were included in the analysis. SIH control was determined by mean BG levels, the number and proportion of elevated and pronouncedly elevated BG readings, and the number of hypoglycaemic events.
60 of 283 patients (21.2%) developed SIH, of which 55 patients were included in further analysis. Mean fasting and daytime BG levels were 7.8 ± 2.9 mmol/l and 10.9 ± 2.2 mmol/l, respectively. 41/55 patients (74.5%) had elevated average BG levels. 45/55 patients (81.8%) had > 5 readings or > 20% of all readings exceeding hyperglycaemia threshold, and 33/55 patients (60.0%) had pronouncedly elevated BG levels on more than one occasion. 6/55 patients (10.9%) experienced more than one hypoglycaemic event or a severe hypoglycaemia. Only 9/55 patients (16.4%) achieved adequate SIH control according to all defined criteria. Pre-existing diabetes and longer duration of hospital treatment with low glucocorticoid dose were significantly associated with poorer glycaemic control (p < 0.001 and p = 0.003, respectively).
Appropriate SIH management was demonstrated to be challenging. According to the defined criteria, adequate glycaemic control during hospitalisation was not achieved in the large majority of patients with SIH.
本研究旨在确定在三级肺病中心住院的患者中类固醇诱导性高血糖（SIH）的发生率，评估住院期间的血糖控制情况，并确定与 SIH 控制相关的因素。
进行了为期 4 个月的回顾性研究。所有在住院期间接受系统糖皮质激素治疗≥2 天且≥2 次血糖升高的患者均纳入分析。通过平均血糖水平、血糖升高和显著升高的次数和比例以及低血糖事件的次数来确定 SIH 的控制情况。
283 例患者中有 60 例（21.2%）发生 SIH，其中 55 例患者纳入进一步分析。空腹和日间平均血糖水平分别为 7.8±2.9mmol/L 和 10.9±2.2mmol/L。41/55 例（74.5%）患者平均血糖水平升高。45/55 例（81.8%）患者有超过 5 次或超过 20%的血糖读数超过高血糖阈值，33/55 例（60.0%）有超过一次血糖显著升高。6/55 例（10.9%）患者经历了一次以上的低血糖事件或严重低血糖。仅 9/55 例（16.4%）患者根据所有定义的标准达到了足够的 SIH 控制。预先存在的糖尿病和接受低剂量糖皮质激素治疗的时间较长与血糖控制不佳显著相关（p<0.001 和 p=0.003）。
适当的 SIH 管理被证明具有挑战性。根据定义的标准，大多数患有 SIH 的患者在住院期间并未达到足够的血糖控制。
