E-Poster 63rd Endocrine Society of Australia Annual Scientific Meeting 2020

Management of glucocorticoid-induced hyperglycaemia in in-patients with acute exacerbation of chronic obstructive pulmonary disease – a retrospective audit (#66)

Kay Hau Choy 1 , Rena Hai Man Cao 1 2 , Lawrence Cai 3 , Sibgat Al Saleheen 3 , Dong Seok Yi 3 , Tang Wong 1 2 , Sarah Abdo 1 4 , Jeff R Flack 1 2 4
  1. Diabetes Centre, Bankstown-Lidcombe Hospital, Bankstown, NSW
  2. Faculty of Medicine, University of New South Wales, Randwick, NSW
  3. Department of Respiratory Medicine, Bankstown-Lidcombe Hospital, Bankstown, NSW
  4. School of Medicine, Western Sydney University, Campbelltown, NSW

Background: Hyperglycaemia is common amongst in-patients receiving glucocorticoids(GCs). Uncontrolled hyperglycaemia is associated with increased morbidity and mortality.

Aim: To review the prevalence and management of glucocorticoid-induced hyperglycaemia(GIH) among in-patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) and to pilot a management guideline.

Methods: An initial retrospective audit was conducted on 30 randomly selected patients (cohort 1) admitted to Bankstown-Lidcombe Hospital with AECOPD, May-August 2017. Data on blood glucose (BGL) monitoring and GIH management were collected. The Respiratory team thence received education on a management guideline. A further audit was conducted for a similar cohort (cohort 2), June-August 2020.

Results: 30 files were reviewed in cohort 1. Most were treated with prednisolone and 80% received steroids for ≥3 days. 63% had no pre-existing diabetes, with almost 60% having ≤1 BGL test throughout their admission. None had an HbA1c done, 2 had ≥1 documented BGL≥12mmol/L, with no follow up action taken. Of those with pre-existing diabetes, only 55% had ≥4 BGL tests per day and 64% had significant hyperglycaemia. 24 patient files were reviewed in cohort 2. Most were treated with prednisolone. 63% had no pre-existing diabetes, of those, 53% had ≤1 BGL test during admission, and only 27% had HbA1c tested before commencing GC. None were commenced on insulin. Of those who had diabetes, almost 90% had ≥4 BGL tests per day with significant hyperglycaemia in 78% and two-thirds either commenced insulin or required insulin dose augmentation. Less than half of the patients were referred to the Endocrinology team.

Conclusion: Guideline education appears to have at least improved the management of patients with known diabetes given the increased proportion having more BGL tests, HbA1c assessment and insulin titration. However, GIH is poorly recognised and sub-optimally managed in this patient cohort. Extensive GIH management education and management guideline implementation are warranted.