Prevalence, predictors, and outcomes of steroid-induced hyperglycemia in hospitalized patients with hematologic malignancies

Abstract

To determine prevalence, predictors, and outcomes of steroid-induced hyperglycemia in hospitalized patients with hematologic malignancies METHODS: We performed retrospective analysis of patients who were hospitalized on any of the four hematology services or bone marrow transplant service and who received systemic steroids during a 2-month period. Mean glucoses for days 1-4 and maximum glucose were calculated and the total daily steroid dose was converted to equivalent dose of dexamethasone. Hyperglycemia was defined as any glucose >9.917 mmol/l during days 1-4. We examined associations between variables using Spearman's correlations and multivariable linear regression RESULTS: 168 patients were included in the analysis. Mean age was 57.1 ± 14.4 years with 59% males and 90% Caucasians. The prevalence of hyperglycemia was 39%. Eight patients received intravenous insulin. In patients without diabetes, steroid dose equivalent to >12 mg dexamethasone and longer acting steroids caused greater degree of hyperglycemia compared to a dose <12 mg. Maximum glucose was a predictor of hospital length of stay among patients without diabetes (but not those with diabetes), and with acute leukemia or stem cell transplant (but not other hematologic malignancies). There were no significant differences in in mortality or other outcomes between the groups with and without hyperglycemia CONCLUSIONS: Hyperglycemia is common in patients with hematologic malignancies, which require frequent corticosteroids. Higher steroid dose and long-acting steroids caused a greater degree of hyperglycemia. Maximum glucose was a predictor of length of stay but this was only significant for patients without diabetes, those with acute hematologic malignancy or stem cell transplant.

Steroid-induced hyperglycemia: An underdiagnosed problem or clinical inertia? A narrative review

“…Indeed, post-prandial capillary hyperglycemia had an incidence of 15.6%, which added to diabetes and prediabetes led the incidence of SIDM among hematologic patients to nearly 50% [28]. Recently, in a cohort of patients with hematologic malignancies requiring frequent, high-dose corticosteroids, hyperglycemia has been described with a prevalence of 39% [29].…”

“…Therefore, glucose monitoring across the first 48 hours is very important in order to identify the most patients developing hyperglycemia, stopping further testing in case of absence of hyperglycemia within the first 48 hours [37]. Table 2 summarizes epidemiological data divided by different conditions according to main recent studies published within 2015 and 2018 [29,[38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54].…”

“…Early hyperglycemia after glucocorticoid initiation has been found as a prominent risk factor for adverse outcome in patients with acute graft-versus-host disease [47]. Among patients with hematologic malignancies under high-dose corticosteroids, maximum glucose values represented a predictor of length of in-hospital stay, in particular among those without prior diabetes [29].…”

Outpatient management of steroid-induced hyperglycaemia and steroid-induced diabetes in people with lymphoproliferative disorders treated with intermittent high dose steroids

“…Our population may have been at increased risk with 26% being of Black African or Caribbean ethnicity, a mean age of 58.6 years and a mean BMI of 27.7 kg/m 2 . In addition, the steroid doses were high, a factor directly correlated with risk of SID [8] , [9] . However this is similar to the incidence of SID in people with haematological malignancies reported previously [4] , [5] , [9] , [10] .…”

Inpatient use of glucocorticoids may mediate the detrimental effect of new-onset hyperglycemia on COVID-19 severity

“…Although the use of glucocorticoids in the setting of COVID-19 has been intensely debated, recent clinical trials have provided supportive evidence for their use in severe cases [3] , [4] . Steroid-induced hyperglycemia is a common metabolic side effect of glucocorticoid treatment in hospitalized patients with and without pre-existing diabetes [5] , [6] . It is reported that 20%–50% of patients without a previous history of diabetes show hyperglycemia after steroid administration [7] , [8] , [9] .…”