Department of Medicine, Division of Endocrinology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York.
Department of Medicine, Division of Endocrinology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, New York.
Endocr Pract. 2022 Nov;28(11):1166-1177. doi: 10.1016/j.eprac.2022.07.014. Epub 2022 Aug 5.
Optimal glucocorticoid-induced hyperglycemia (GCIH) management is unclear. The COVID-19 pandemic has made this issue more prominent because dexamethasone became the standard of care in patients needing respiratory support. This systematic review aimed to describe the management of GCIH and summarize available management strategies for dexamethasone-associated hyperglycemia in patients with COVID-19.
A systematic review was conducted using the PubMed/MEDLINE, Cochrane Library, Embase, and Web of Science databases with results from 2011 through January 2022. Keywords included synonyms for "steroid-induced diabetes" or "steroid-induced hyperglycemia." Randomized controlled trials (RCTs) were included for review of GCIH management. All studies focusing on dexamethasone-associated hyperglycemia in COVID-19 were included regardless of study quality.
Initial search for non-COVID GCIH identified 1230 references. After screening and review, 33 articles were included in the non-COVID section of this systematic review. Initial search for COVID-19-related management of dexamethasone-associated hyperglycemia in COVID-19 identified 63 references, whereas 7 of these were included in the COVID-19 section. RCTs of management strategies were scarce, did not use standard definitions for hyperglycemia, evaluated a variety of treatment strategies with varying primary end points, and were generally not found to be effective except for Neutral Protamine Hagedorn insulin added to basal-bolus regimens.
Few RCTs are available evaluating GCIH management. Further studies are needed to support the formulation of clinical guidelines for GCIH especially given the widespread use of dexamethasone during the COVID-19 pandemic.
糖皮质激素诱导的高血糖（GCIH）的最佳管理方法尚不清楚。由于地塞米松成为需要呼吸支持的患者的标准治疗方法，COVID-19 大流行使这个问题更加突出。本系统评价旨在描述 GCIH 的管理，并总结 COVID-19 患者中与地塞米松相关的高血糖的可用管理策略。
使用 PubMed/MEDLINE、Cochrane 图书馆、Embase 和 Web of Science 数据库进行系统评价，检索结果时间为 2011 年至 2022 年 1 月。关键词包括“类固醇诱导性糖尿病”或“类固醇诱导性高血糖”的同义词。纳入了关于 GCIH 管理的随机对照试验（RCT）。所有关于 COVID-19 中与地塞米松相关的高血糖的研究均被纳入，无论研究质量如何。
最初搜索非 COVID-19 的 GCIH 确定了 1230 篇参考文献。经过筛选和审查，33 篇文章被纳入本系统评价的非 COVID-19 部分。最初搜索 COVID-19 相关的地塞米松治疗 COVID-19 相关的高血糖管理，确定了 63 篇参考文献，其中 7 篇被纳入 COVID-19 部分。管理策略的 RCT 很少，没有使用高血糖的标准定义，评估了各种治疗策略，其主要终点不同，并且除了添加到基础-餐时方案中的中性鱼精蛋白锌胰岛素外，一般都没有被发现有效。
评估 GCIH 管理的 RCT 很少。鉴于 COVID-19 大流行期间地塞米松的广泛使用，需要进一步的研究来支持 GCIH 临床指南的制定。
