Improving care for children at risk of steroid-induced hyperglycaemia: integrating proactive monitoring into routine hospital care

Mai Ali

doi:10.1530/endoabs.111.P113

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Endocrine Abstracts (2025) 111 P113 | DOI: 10.1530/endoabs.111.P113

BSPED2025 Poster Presentations Diabetes 6 (10 abstracts)

Improving care for children at risk of steroid-induced hyperglycaemia: integrating proactive monitoring into routine hospital care

Mai Ali

Author affiliations

Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom

Background: Steroid-induced hyperglycaemia (SIH) is a recognised but under-monitored complication in children receiving high-dose corticosteroids for oncological, nephrological, or immunosuppressive indications. Delayed recognition can result in significant metabolic deterioration, prolonged admission, and missed opportunities for early intervention, particularly in patients without pre-existing diabetes.

Aim: To identify system-level barriers to early detection and management of SIH in paediatric inpatients and design a practical pathway to embed proactive glucose monitoring into routine hospital care.

Methods: A retrospective review was conducted between November 2024 and February 2025 at Leeds Children’s Hospital. Seven cases of SIH (defined as ≥14 mmol/l post-steroid initiation) were identified in children under the care of oncology, nephrology, and hepatology teams. Audit data were triangulated with multidisciplinary feedback to develop a targeted quality improvement framework.

Table 1 Key Barriers & Proposed Interventions in SIH Care:
Identified Barrier	Intervention
Limited awareness of SIH risk and monitoring protocols among non-diabetes teams	MDT education, ward posters, CGM teaching sessions
No standardised local standard operating procedure (SOP) for SIH detection & referral	Development of local SIH SOP with glucose thresholds
Inadequate family awareness and engagement	Tailored SIH leaflets + diabetes specialised nurse (DSN) involvement at steroid initiation
Delayed diabetes team escalation in borderline cases	Proposed EHR-based automatic referral triggers (e.g. >14 mmol/l) for at risk patients.

Conclusion: SIH in paediatrics is frequently under-recognised outside of diabetes-specialist settings. This project highlights a scalable, MDT-driven approach to improve early identification, family communication, and escalation of care. A re-audit is planned to assess the impact of implemented interventions. Wider adoption of proactive SIH monitoring can enhance patient safety and align care with paediatric endocrinology best practice.