Risk of Future Type 2 Diabetes Mellitus in Patients Developing Steroid-Induced Hyperglycemia During Hospitalization for Chronic Obstructive Pulmonary Disease Exacerbation

Upadhyay, Jagriti; Trivedi, Nitin; Lal, Amos

doi:10.1007/s00408-020-00356-z

Cited by 14 publications

(10 citation statements)

References 38 publications

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“…We suggest a close watch for DIDM in children with a past history of DIDM during reexposure to steroids. 36,37 In addition, close watch for symptoms of hyperglycemia and immediate glucose testing with the onset of hyperglycemic symptoms, to be considered throughout the period of steroid exposure. When on L-asparaginase alone (without steroids), we suggest 2 to 3 random glucose testings in the first week, followed by as and when required in case of hyperglycemia symptoms, until completion of therapy.…”

Section: Diagnosis Of Didm During All-directed Chemotherapymentioning

confidence: 99%

Drug Induced Diabetes Mellitus in Pediatric Acute Lymphoblastic Leukemia: Approach to Diagnosis and Management

Handattu¹,

Sharma

Vijayasekharan

et al. 2022

Journal of Pediatric Hematology/Oncology

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Corticosteroids and L-asparaginase used in the treatment of pediatric acute lymphoblastic leukemia (ALL) can cause drug-induced diabetes mellitus (DIDM). DIDM can lead to dyselectrolytemia, a higher risk of infections including cellulitis, bacteremia, fungemia, and a higher incidence of febrile neutropenia and may have an impact on the outcome of ALL. Literature on the management of DIDM among children with ALL is sparse and the diagnostic criteria for pediatric diabetes should be carefully applied considering the acute and transient nature of DIDM during ALL therapy. Insulin remains the standard of care for DIDM management and the choice of Insulin regimen (standalone Neutral Protamine Hagedorn or basal bolus) should be based on the type and dose of steroids used for ALL and the pattern of hyperglycemia. A modest glycemic control (postmeal 140 to 180 mg/ dL, premeal <140 mg/dL) to prevent complications of hyperglycemia, as well as hypoglycemia, would be the general approach. This review is intended to suggest evidence-based practical guidance in the diagnosis and management of DIDM during pediatric ALL therapy.

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Section: Diagnosis Of Didm During All-directed Chemotherapymentioning

confidence: 99%

Drug Induced Diabetes Mellitus in Pediatric Acute Lymphoblastic Leukemia: Approach to Diagnosis and Management

Handattu¹,

Sharma

Vijayasekharan

et al. 2022

Journal of Pediatric Hematology/Oncology

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“…The risk of admission to an intensive care unit (ICU) or re-exacerbations after the first month appears to be unaltered [2,3]. Corticosteroids affect the expression of various genes, especially those regulating the innate and the adaptive immune system [4], leading to a variety of beneficial and harmful effects [5][6][7][8] such as increasing the risk of acute or chronic infections [9,10], the onset or aggravation of diabetes mellitus [11,12], and osteoporotic fractures [9]. Therefore, minimising the unnecessary exposure of patients with chronic obstructive pulmonary disease (COPD) exacerbations to systemic corticosteroids is crucial.…”

Section: Background and Rationalementioning

confidence: 99%

“…We would also like to thank the COP:TRIN Steering Committee for their helpful advice. 11 The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK. 12…”

Section: Acknowledgementsmentioning

confidence: 99%

Effect of different corticosteroid regimes for hospitalised patients with exacerbated COPD: pooled analysis of individual participant data from the REDUCE and CORTICO-COP trials

et al. 2021

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Background Systemic corticosteroid administration for severe acute exacerbations of COPD (AECOPD) reduces the duration of hospital stays. Corticosteroid-sparing regimens have showed non-inferiority to higher accumulated dose regimens regarding re-exacerbation risk in patients with AECOPD. However, it remains unclear whether 14-day or 2–5-day regimens would result in shorter admission durations and changes in mortality risk. We explored this by analysing the number of days alive and out of hospital based on two randomised controlled trials with different corticosteroid regimens. Methods We pooled individual patient data from the two available multicentre randomised trials on corticosteroid-sparing regimens for AECOPD: the REDUCE (n = 314) and CORTICO-COP (n = 318) trials. In the 14-day regimen group, patients were older, fewer patients received pre-treatment with antibiotics and more patients received pre-treatment with systemic corticosteroids. Patients randomly allocated to the 14-day and 2–5-day regimens were compared, with adjustment for baseline differences. Results The number of days alive and out of hospital within 14 days from recruitment was higher for the 2–5 day regimen group (mean 8.4 days; 95% confidence interval [CI] 8.0–8.8) than the 14-day regimen patient group (4.2 days; 95% CI3.4–4.9; p < 0.001). The 14-day AECOPD group had longer hospital stays (mean difference, 5.4 days [standard error ± 0.6]; p < 0.0001) and decreased likelihood of discharge within 30 days (hazard ratio [HR] 0.5; 95% CI 0.4–0.6; p < 0.0001). Comparing the 14-day regimen and the 2–5 day regimen group showed no differences in the composite endpoint ‘death or ICU admission’ (odds ratio [OR] 1.4; 95% CI 0.8–2.3; p = 0.15), new or aggravated hypertension (OR 1.5; 95% CI 0.9–2.7; p = 0.15), or mortality risk (HR 0.8; 95% CI 0.4–1.5; p = 0.45) during the 6-month follow-up period. Conclusion 14-day corticosteroid regimens were associated with longer hospital stays and fewer days alive and out of hospital within 14 days, with no apparent 6-month benefit regarding death or admission to ICU in COPD patients. Our results favour 2–5 day regimens for treating COPD exacerbations. However, prospective studies are needed to validate these findings.

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“…In their report dated 20 th March 2020, CDC mentions that 20% of the hospitalized patients and 12% of the intensive care patients from US belong to age range of 20 to 44 years (10). Amongst the comorbidities, hypertension, cardiovascular disorders, cerebrovascular disorders and diabetes are the top medical conditions who had more severe disease and required intensive care as compared to individuals without these comorbidities (7)(8)(9)(10)(11)(12)(13)(14)(15)(16). Specific subset of population like patients suffering from cancer, transplant recipients or other benign blood disorders need special attention for their underlying disease (17)(18)(19)(20).…”

Section: Demographic Details Of the Patientsmentioning

confidence: 99%

Trajectory of the COVID-19 pandemic: chasing a moving target

Sahu¹,

Mishra²,

Lal³

2020

Ann Transl Med

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The spread of COVID-19 has already taken a pandemic form, affecting over 180 countries in a matter of three months. The full continuum of disease ranges from mild, self-limiting illness to severe progressive COVID-19 pneumonia, multiorgan failure, cytokine storm and death. Younger and healthy population is now getting affected than before. Possibilities of airborne and fecal oral routes of transmission has increased the concern. In the absence of any specific therapeutic agent for coronavirus infections, the most effective manner to contain this pandemic is probably the non-pharmacological interventions (NPIs).The damage due to the pandemic disease is multifaceted and crippling to economy, trade, and health of the citizens of the countries. The extent of damage in such scenarios is something that is beyond calculation by Gross Domestic Product rate or currency value of the country. Unfortunately, unlike many other diseases, we are still away from the target antiviral drug and vaccine for severe acute respiratory syndrome (SARS-CoV-2) infection. The prime importance of NPIs like social distancing, staying in home, work from home, self-monitoring, public awareness, self-quarantine, etc. are constantly being emphasized by CDC, WHO, health ministries of all countries and social media houses. This is time of introspection and learning from our mistakes. Countries like China and South Korea who were initially the most hit countries could contain the disease spread by liberal testing of their population, stringent quarantine of people under investigation and isolation of the positive cases. Rest of the countries need to act urgently as well to bring an immediate halt in the community transmission.

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Risk of Future Type 2 Diabetes Mellitus in Patients Developing Steroid-Induced Hyperglycemia During Hospitalization for Chronic Obstructive Pulmonary Disease Exacerbation

Cited by 14 publications

References 38 publications

Drug Induced Diabetes Mellitus in Pediatric Acute Lymphoblastic Leukemia: Approach to Diagnosis and Management

Drug Induced Diabetes Mellitus in Pediatric Acute Lymphoblastic Leukemia: Approach to Diagnosis and Management

Effect of different corticosteroid regimes for hospitalised patients with exacerbated COPD: pooled analysis of individual participant data from the REDUCE and CORTICO-COP trials

Trajectory of the COVID-19 pandemic: chasing a moving target

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