Introduction: We undertook an audit evaluating the glycaemic management of patients on steroids. This audit is based on the Joint British Diabetes Societies guideline on Management of Hyperglycaemia and Steroid (Glucocorticoid) Therapy, 2014.
Method: The audit was conducted prospectively over a period of 5 days. All patients on steroids greater than 5 mg of Prednisolone, or an equivalent dose of alternative synthetic glucocorticoid were included. The pilot audit was conducted on the Acute Medical Unit, Respiratory Wards and Haematology Wards at Manchester Royal Infirmary.
Results: A total of 38 patients were identified.
Types of steroids used:: Prednisolone: 34 patients
Hydrocortisone: 2 patients
Dexamethasone: 2 patients
Methylprednisolone: 2 patients
* both the patients on Methylprednisolone were subsequently changed to Prednisolone after 3 days as part of their chemotherapy regime.
The main indication for high dose steroid was for asthma/chronic obstructive pulmonary disease (COPD) exacerbation; 26/38 (68.4%). Other indications (each with 12 patients each) were for B Cell Lymphoma, Lung cancer, Chronic Lymphocytic Lymphoma, Graft versus Host Disease, Sarcoidosis, Vasculitis, Ulcerative Colitis, Uticaria, Interstitial Lung Disease and Asbestosis.
9/38 (24%) patients were diabetic, and 56% of them did not have intensification of their existing diabetic regime when required.
In the non-diabetic population, only 3/29 (10.3%) had blood glucose monitoring.
Recommendations: Most steroid use is usually less than 5 days, but 22% is for greater than 6 months and 4.3% longer than 5 years. We already know that steroid increases post-prandial glucose levels. The fluctuation in blood glucose levels is associated with increased cardiovascular mortality. However, more research is still needed. From this, we feel that in-patients on steroid doses greater than physiological doses should have should have their blood glucose measured while in hospital. On discharge with steroids, they should be advised on symptoms of diabetes and seek advice/treatment early.