Steroid-Induced Hyperglycaemia on the General Ward: A Review of the Predictable Complication That No Specialty Owns
DOI:
https://doi.org/10.5281/zenodo.22254545Keywords:
Glucocorticoids, Steroid-induced hyperglycaemia, Inpatient diabetes, Glucose monitoring, Clinical inertiaAbstract
More than one in ten hospital inpatients receives a glucocorticoid, and hyperglycaemia is among the most predictable
consequences of doing so. It is also among the least reliably detected. Glucose rises four to six hours after a morning dose of
prednisolone and may stay raised for 12 to 24 hours, which means a fasting or pre-breakfast measurement, the one most likely to
be taken, is the measurement least likely to find it. Continuous monitoring of patients receiving high-dose glucocorticoids for
dermatological disease detected hyperglycaemia in 47.1 per cent, with affected patients spending close to six hours a day above
the target range. Incidence roughly doubled with each step in baseline glycaemic status, from 2 of 10 with normoglycaemia to 9 of
10 with established diabetes. In an inflammatory bowel disease cohort, peak glucose occurred on day two in 60 per cent but was
not reached until day seven in 14 per cent. This review sets out why the complication is missed, what national guidance
recommends, and why responsibility for it falls between specialties.
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