Background: Glucocorticoids are used medium and long-term for a variety of inflammatory and autoimmune conditions, with increasing use in the UK. The management of their potential side effects, however, remains suboptimal, and guidelines are not comprehensive. Our institute has had cases of patients presenting with hyperglycaemic emergencies due to steroid induced diabetes.
Aims: 1) To obtain an estimate of the frequency of the use of medium and long term glucocorticoids in our DGH outpatients. 2) To explore whether general practitioners were being requested to monitor for the occurrence of steroid induced diabetes in these patients. 3) To determine whether patients with diabetes on long term steroid treatment were being advised about worsening of their glycaemia
Methods: Retrospective casenote analysis of all outpatients in the specialities of haematology, gastroenterology, respiratory and rheumatology over a 1 week period in June 2018.
Results: Following the exclusion of sleep clinic and haem-onc patients undergoing chemotherapy (for whom a new protocol is being trialled), a total of 556 records were examined. 41 patients were treated with glucocorticoids (19M, 23F; mean age 61). 31 patients had prednisolone, 4 budesonide, 1 dexamethasone and 5 depomedrone (4IM, 1IA). The length of oral steroid use varied from 3 weeks to over 40 years. 6 patients had pre-treatment diabetes; 5 had HbA1cs (mean 58 mmol/mol, range 3894). 1/6 had consideration of diabetes recorded, with none of patient information about the risk or need for increased vigilance. Of the remainder, only 1/35 had plans for consideration of hyperglycaemia.
Conclusions: About 7% of patients attending outpatients in selected specialities are on medium or long term glucocorticoid therapy. Extrapolating this data, it is possible over 1500 patients attending our hospital may be on this treatment. The monitoring of these patients from a hyperglycaemia perspective is poor, and there is opportunity for hospitals to develop protocols to inform patients and GPs of the risks to try to avoid symptomatic hyperglycaemia, and indeed hyperglycaemic emergencies.
18 - 21 May 2019
European Society of Endocrinology