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Perspectives

Glucocorticoid-induced hyperglycaemia: common but easily missed

Tien F Lee, Li M Ng, Stephen Stranks

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Abstract

Screening for glucocorticoid-induced hyperglycaemia is important because hyperglycaemia is associated with reduced quality of life, increased rates of infections, poor wound healing, falls and increased long-term risks of macrovascular complications. Management includes general lifestyle modifications, consideration of oral hypoglycaemic agents and/or insulin, and cardiovascular risk factor management.

Key Points

  • Glucocorticoid-induced hyperglycaemia is common and the diagnosis is often missed.
  • Patients should ideally be screened for pre-existing diabetes before commencing glucocorticoids.
  • Blood glucose levels tend to rise postprandially, particularly in the afternoon and evening, in patients taking a morning dose of prednisolone (e.g. in people with chronic obstructive pulmonary disease). Fasting blood glucose levels may be affected in patients taking high doses or long-acting glucocorticoids.
  • Screening for glucocorticoid-induced hyperglycaemia should be performed by: – measuring plasma glucose levels two hours after lunch or dinner (11.1 mmol/L or more) – measuring random evening plasma glucose levels (11.1mmol/L or more) – performing a standardised oral glucose tolerance test.
  • Asymptomatic patients require two abnormal plasma glucose levels for a definitive diagnosis.
  • Measurement of fasting plasma glucose levels has poor sensitivity for diagnosing glucocorticoid-induced hyperglycaemia.
  • Management of people with glucocorticoid-induced hyperglycaemia should include general lifestyle modifications, consideration of oral hypoglycaemic agents and/or insulin, and cardiovascular risk factor management.

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