1276-PUB: Diagnosis and Management of Inpatient Corticosteroid-Induced Hyperglycaemia in an Acute Respiratory Cohort in a Tertiary Centre

Corticosteroid-induced hyperglycaemia (CIH) is commonly encountered among acute respiratory inpatients, particularly those with diabetes mellitus (DM). Guidelines dictate frequency of inpatient capillary blood glucose (CBG) monitoring and treatment modification in the context of exogenous corticosteroid administration. Patients admitted with acute respiratory illness requiring corticosteroids were reviewed to evaluate monitoring, diagnosis and treatment of CIH. A re-audit was performed at a 3-month interval. Twenty patients were treated acutely with corticosteroids; median age 68 years (range 40-88); 13 male. Seven of these patients were diabetic; 6 type 2 DM; 1 type 1 DM. The most common conditions requiring admission included COPD, IPF, pneumonia, asthma, covid-19 and lung cancer. Of the twenty patients included, 13/20 (65%) had CBG monitoring. Within the monitored group, 6/13 (46%) showed readings consistent with hyperglycaemia (>12mmol/L) on more than one reading, of whom all were diabetic. Patients who exhibited hyperglycaemia had appropriate escalation of CBG checks in 3/6 (50%) cases. One patient of six (17%) with persistent CIH was treated appropriately with oral hypoglycaemics. The remaining five patients remained untreated. After education of respiratory medical staff, re-audit revealed persistently infrequent CBG checks (8/15 monitored - 53%). However, of those monitored, escalation of treatment was undertaken in 2/3 cases (67%) in cases of CIH. A high proportion of respiratory inpatients require treatment acutely with corticosteroids. Co-existent DM indicates a higher likelihood of developing CIH. Overall, CBG checks are sporadically performed despite hyperglycaemia. Appropriate treatment escalation of CIH is inadequate. Further education of medical and nursing staff regarding CIH guidelines is required for optimal glycaemic control in this cohort.