1641-P: Development and Validation of a Clinical Predictive Score for Insulin Requirement during Glucocorticoid Treatment

Insulin is often administered for glucocorticoid (GC) -induced hyperglycemia. We have developed and validated a scoring system to predict insulin requirement for optimal control of hyperglycemia during GC treatment through retrospective studies. The Developing set: 303 adults out of 2718 patients, undergoing their first treatment of prednisolone (PSL) with a dosage of 5 mg/day or more for 4 weeks at least, were divided into 2 groups depending on with or without administration of insulin during GC treatment. Risk factors for insulin requirement were identified by a stepwise logistic regression analysis after univariate analyses of clinical parameters before GC treatment between the 2 groups. We constructed a point-addition scoring system, consisting of several categories and their coefficients in each risk factor, derived from another multivariate analysis. We validated it to validation sets A (n=44) and B (n=77) in another two facilities, respectively. Male, FPG, HbA1c, serum CRE, and an initial dose of PSL were identified as the risk factors. The AUC by ROC analysis of the total scores when the Developing set was scored, showed 0.94. The sensitivity, specificity, and accuracy were 90%, 88%, and 88%; 88%, 67%, and 71%; 83%, 76%, and 77% in the Developing set, Validation set A, and B, respectively if the cut off value of the total scores was defined as 19 points. The scoring system: Table is useful.