Original Research
Monday, October 14, 2024
01:00 PM–02:30 PM
Abstract
Introduction:
Insulin is commonly used for managing steroid induced hyperglycemia (SIH), but the optimal dosing strategies are not established. The majority of the literature on SIH management focuses on intermediate-acting steroids with limited reported experience on SIH management caused by long-acting steroids such as dexamethasone. This study aimed to evaluate insulin glargine use in managing dexamethasone-induced hyperglycemia.
Research Question or Hypothesis:
What percentage of patients who received once-daily insulin glargine and dexamethasone combination therapy achieved euglycemia by day three?
Study Design:
Single-center, retrospective, cohort study
Methods:
Adult patients admitted during July 1, 2021 and July 31, 2023 who received insulin glargine and dexamethasone for at least three consecutive days were screened. Exclusions were applied for patients with Type I diabetes mellitus, not receiving once-daily administration of either, or initiation of continuous insulin infusion within the first three days. The primary outcome was the percentage of patients achieving euglycemia (mean blood glucose 70-180 mg/dL) on day three of combination therapy.
Results:
Among 733 screened patients, 118 were included in the analysis. The most common indication for dexamethasone use was COVID-19 (55.1%) followed by hematologic malignancies (16.1%). Euglycemia was achieved by 28 patients (24%) on day three. The mean body mass index (BMI) and presence of Type II diabetes mellitus diagnosis were found to be significantly lower in the euglycemia cohort than non-euglycemia cohort (29.1 vs. 33.7 kg/m², p = 0.019; 85.7% vs. 97.8%, p = 0.028, respectively). The standardized mean insulin glargine dose was 0.04 vs. 0.03 units/mg dexamethasone/kg in the euglycemia cohort compared to the non-euglycemia cohort (p = 0.14), with a median correctional insulin dose of 6 [IQR 4-15] vs. 24 [IQR 15-45] units, respectively. One patient in the euglycemia cohort developed hypoglycemia.
Conclusion:
Achieving early euglycemia with insulin glargine for dexamethasone-induced hyperglycemia remains challenging. Lower BMI and absence of pre-existing Type II diabetes mellitus were associated with success.
Presenting Author
Yijie Cheng PharmDThe Ohio State University Wexner Medical Center
Authors
Kathleen Dungan MD, MPH
The Ohio State University Wexner Medical Center
Joshua Gaborcik PharmD, BCPS
The Ohio State University Wexner Medical Center
Rachel Smith PhD, MPH
The Ohio State University Wexner Medical Center
Andrew Stone PharmD, BCPS
The Ohio State University Wexner Medical Center