Management of Hyperglycemia in Diabetic Patients with Hematologic Malignancies During Dexamethasone Therapy

doi:10.4158/EP12256.OR

Endocrine Practice

Volume 19, Issue 2, March–April 2013, Pages 231-235

https://doi.org/10.4158/EP12256.OR Get rights and content

ABSTRACT

Objective

To compare the response to different insulin regimens for management of hyperglycemia in diabetic patients with hematologic malignancies who are receiving dexamethasone.

Methods

A retrospective analysis was conducted to determine whether a basal bolus insulin (BBI) regimen with detemir and aspart is superior to a sliding scale regular insulin (SSI) regimen for management of hyperglycemia in hospitalized diabetic patients receiving dexamethasone.

Results

Forty patients with hematologic malignancies were treated with intravenous (8 to 12 mg/day) or oral (40 mg/day) dexamethasone for 3 days. The average blood glucose (BG) level was 301 ± 57 mg/dL in the SSI group (n = 28) and 219 ± 51 mg/dL in the BBI group (n = 12) (P <.001). The BBI regimen resulted in an average BG reduction of 52 ± 82 mg/dL throughout the course of dexa-methasone therapy, while the SSI regimen produced an increase in the mean daily BG level of 128 ± 77 mg/dL (P <.001). On the last day of dexamethasone administration, the insulin requirement was 49 ± 29 units/day in the SSI group and 122 ± 39 units/day in the BBI group (P <.001). Three patients in the SSI group developed diabetic ketoacidosis or hyperosmolar hyperglycemia during steroid therapy. No hypoglycemia was observed in either group. The length of stay and infection rates were similar between groups.

Conclusion

Basal and bolus insulin regimen is an effective and safe approach for managing dexamethasone-induced hyperglycemia in hospitalized patients with hematologic malignancies. (Endocr Pract. 2013;19:231-235)

Section snippets

INTRODUCTION

Uncontrolled hyperglycemia is associated with adverse outcomes in hospitalized diabetic patients (1). In patients with hematologic malignancies admitted for bone marrow transplantation, corticosteroid-induced hyperglycemia is accompanied by poor clinical outcome (2,3). Sliding scale insulin (SSI) regimes are commonly prescribed by non-endocrinologists for managing hyperglycemia in hospitalized patients (4); however, this method of insulin administration addresses neither the physiological

Subjects

We conducted a retrospective chart review of patients admitted to the malignant hematology ward at Methodist University Hospital, Memphis, Tennessee, between August 1, 2009, and July 30, 2011. Patients with self-reported diagnosis of diabetes mellitus and hematologic malignancies who received therapy with dexamethasone for 3 days were included in the study. Other hospitalized patients with diabetes who did not receive dexamethasone therapy were excluded from the analysis. Information on

RESULTS

We identified 40 patients with known diagnosis of type 2 diabetes mellitus who received dexamethasone during hospitalization. Dexamethasone was administered intravenously (8 to 12 mg/day) to 27 patients and orally (40 mg/day) to 13 patients. There was no significant difference in the average daily intravenous dexamethasone dose between the BBI group (9.3 ± 1.8 mg) and the SSI group (8.8 ± 1.5 mg). In our preliminary analyses, we found that glycemic trends and outcomes were identical in both the

DISCUSSION

Few studies have evaluated the efficacy of different insulin regimens in the management of steroid-induced hyperglycemia in hospitalized patients with diabetes. We found that treatment with the BBI regimen was more effective than the SSI regimen in managing hyperglycemia, while the standard SSI therapeutic regimen was likely to be associated with the development of hyperglycemic crises during dexamethasone therapy.

Hyperglycemia in patients with hematologic malignancies is associated with poor

CONCLUSION

In summary, the results of this retrospective analysis suggest that the basal and bolus insulin regimen is safe and also more effective than the sliding scale insulin regimen for inpatient management of steroid-exacerbated hyperglycemia in diabetic patients with hematologic malignancies.

DISCLOSURE

The authors have no multiplicity of interest to disclose.

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Original ArticlesDexamethasone TherapyManagement of Hyperglycemia in Diabetic Patients with Hematologic Malignancies During Dexamethasone Therapy

ABSTRACT

Objective

Methods

Results

Conclusion

Section snippets

INTRODUCTION

Subjects

RESULTS

DISCUSSION

CONCLUSION

DISCLOSURE

Am J Med

Endocr Pract

Endocr Pract

Management of hyperglycemia in hospitalized patients in non-critical care setting: an endocrine society clinical practice guideline

J Clin Endocrinol Metab

Antecedent hyperglycemia is associated with an increased risk of neutropenic infections during bone marrow transplantation

Diabetes Care

Hyperglycemia and length of stay in patients hospitalized for bone marrow transplantation

Diabetes Care

Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes undergoing general surgery (RABBIT 2 surgery)

Diabetes Care

Randomized study of basal-bolus insulin therapy in the inpatient management of patients with type 2 diabetes (RABBIT 2 trial)

Diabetes Care

Original Articles
Dexamethasone Therapy
Management of Hyperglycemia in Diabetic Patients with Hematologic Malignancies During Dexamethasone Therapy