Effects of steroid stewardship on glycemic control in acute exacerbations of chronic obstructive pulmonary disease patients

Abstract

Introduction The adverse effects of corticosteroids are dose‐dependent, and guidance is to use the lowest effective dose in most disease states. The study facility recently reported a steroid stewardship program that reduced steroid dosing in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) patients by 50%. The purpose of this post‐hoc analysis was to evaluate the effect of this intervention on glycemic control in hospitalized AECOPD before and after cohorts. Methods This was a retrospective post‐hoc review of hospitalized patients in a before and after study design (n = 27 in each group). The primary endpoint was the proportion of glucose readings >180 mg/dL. Baseline characteristics, mean glucose levels, and corrective insulin were also collected. Continuous variables were compared with a Student's t‐test (or Mann–Whitney U where appropriate) and nominal variables with a chi‐square test in R Studio. Results There was a significantly higher proportion of glucose >180 mg/dL readings in the pre‐intervention cohort: 38% vs. 25% (p = 0.007). The mean glucose levels were numerically lower post‐intervention but did not reach statistical significance (160 mg/dL vs. 145 mg/dL, p = 0.27) both in diabetics (192 mg/dL vs. 181 mg/dl, p = 0.69) and non‐diabetics (142 mg/dL vs. 125 mg/dL, p = 0.08). The use of correctional insulin was similar: a median of 25 units vs. 24.5 units (p = 0.92). Conclusion A stewardship program focused on steroid reduction in AECOPD significantly lowered the proportion of hyperglycemic readings but did not significantly affect mean glucose and corrective insulin usage while hospitalized.