Introduction: Adrenal insufficiency (AI) is a potentially life-threatening condition associated with increased mortality, necessitating lifelong steroid replacement, typically with hydrocortisone or prednisolone. This pilot study investigates the frequency of nocturnal hypoglycaemia in adults with insulin-treated diabetes mellitus (DM) and AI, comparing the effects of prednisolone and hydrocortisone. The study aims to explore potential factors contributing to the mortality excess observed in this population.

Methods: This was a prospective observational study recruiting adults with insulin-treated DM and AI, and a control group with AI without DM. Participants were matched for age, sex, and steroid replacement. Participants were provided with continuous glucose monitoring (CGM; Dexcom G6) for 30 days and data were analysed for percentage times in range.

Results: Amongst 27 participants with AI recruited, 13 were female, mean age was 54.7±8.9 years and 13 also lived with DM. Of these, median time spent in nocturnal hypoglycaemia (<3.9mmol/L) was 0.7% (0.5% with hydrocortisone, 0.8% with prednisolone. Statistically significant differences were not found between prednisolone and hydrocortisone users. Clinically significant findings revealed higher time above 10mmol/L and lower time in the target range (3.9-10mmol/L) in participants with DM taking prednisolone.

Conclusion: We present the first data on glycaemic patterns from CGM in individuals with both DM and AI, establishing pilot data for nocturnal and diurnal hypoglycaemia. Potentially clinically important hyperglycaemia was identified in those living with DM on prednisolone. These findings highlight the need for larger sample sizes to explore potential implications for cardiovascular risk and mortality in this vulnerable population. The findings contribute novel insights aiming to enhance patient safety in managing both DM and AI.

Disclosure

S. Khan: None. M. Reddy: None. N. Oliver: Advisory Panel; Dexcom, Inc., Medtronic, Roche Diabetes Care. Speaker's Bureau; Sanofi, Tandem Diabetes Care, Inc. Research Support; Dexcom, Inc., Medtronic. V. McKechnie: None. P. Avari: None.

Funding

Imperial Health Charity UK

© 2024 by the American Diabetes Association
2024
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