28 April 2021: Articles
Glycemic Profile of Intravenous Dexamethasone-Induced Hyperglycemia Using Continuous Glucose Monitoring
Unusual clinical course, Unusual or unexpected effect of treatment, Educational Purpose (only if useful for a systematic review or synthesis)
Fan Zhang A* , Jocelyne G. Karam ADOI: 10.12659/AJCR.930733
Am J Case Rep 2021; 22:e930733
Table 2. Studies of glucocorticoid-induced hyperglycemia by CGM.
| Author, year | Steroid | Study design | Patients | Results | Conclusion |
|---|---|---|---|---|---|
| Burt, 2011 []12 | Prednisolone oral at least 20 mg daily | Cross-sectional study | 60 patients with COPD including 7 patients T2DM | 24 h CGM showed postprandial hyperglycemia begin at 3 h, peak occurs after 5–8 h with 20% higher glucose, and wears off overnight | Prednisolone predominantly cause hyperglycemia in the afternoon and evening. |
| Ruiz de Adana, 2015 []18 | Methylprednisolone (>40 mg/d) or deflazacort (>60 mg/d) more than once daily | Randomized clinical trial | 53 patients with T2DM treated for respiratory disease | 24 h CGM showed postprandial hyperglycemia begins at3 h, peak occur after 5–8 h with 20% higher glucose, and wears off overnight | Insulin glargine and NPH are equally effective in a basal-bolus insulin protocol. |
| Kishimoto, 2015 []17 | Dexamethasone 20 mg once a week as a part of treatment for multiple myeloma | Case Report | A non-insulin treated T2DM 76-year-old woman, on glimepiride, miglitol, alogliptin HA1C 7.9% | 4 days CGM showed postprandial hyperglycemia lasting to the next day, although received regular insulin 6 units every 6 h for 2 days after dexamethasone | Dexamethasone induced postprandial hyperglycemia mainly in the afternoon, persisted the next day, and attenuated one day later |
| Gerards, 2016 []9 | Prednisone equivalent >12.5 mg for 3–10 days with chemotherapy (median dose 50 mg, dexamethasone 8 mg) | Randomized crossover study | 26 patients with T2DM or previous GID treated with antineoplastic chemotherapy | 24 h CGM showed hyperglycemia starting from 8 h and steady high more than 24 h. IMI resulted in a higher proportion of glucose values within target range than SSI | Once-daily IMI results in better glycemic control than SSI |
| Yata, 2017 []19 | Prednisolone 25 mg to 60 mg oral once or twice daily | Retrospectivestudy | 11 patients with GID and CKD without pre-existing DM | 24 h CGM showed postprandial hyperglycemia after 3 meals, they were all improved after starting DPP-4 inhibitors | DPP-4 inhibitors can reduce glucose variability for GID |
| Lyall, 2018 []10 | Dexamethasone 4 mg twice daily (with the first dose 20 mg) for totally 4 days, combined chemotherapy for gynecological cancer | Prospective study | 16 patients without pre-existing DM | 5 days CGM showed hyperglycemia throughout the 24 h period, predominantly in the afternoon and evening | All patient developed hyperglycemia. The severity and duration are independently associated with HA1C. |
| Tanaka, 2018 []20 | Methylprednisolone 500 mg IV daily for 3 days (the weekly cycle repeated for 3 cycles) | Crossover study | 5 patients without pre-existing DM treated for thyroid ophthalmopathy | 3 days CGM showed postprandial hyperglycemia developed in 2 to 3 h and sustained for 12 h | All patient developed GID. Repaglinide has better control of postprandial hyperglycemia compared with mitiglinide |
| IV – intravenous; CGM – continuous glucose monitoring; COPD – chronic obstructive pulmonary disease; GID – glucocorticoid-induced diabetes; IMI – intermediate-acting insulin; SSI – short-acting sliding-scale insulin; T2DM – type 2 diabetes; CKD – chronic kidney disease; DPP-4 – dipeptidyl peptidase 4; NPH – neutral protamine hagedorn; Ref – reference. | |||||