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Parag Shah,1 Sanjay Kalra,2 Yogesh Yadav,3 Nilakshi Deka,4 Tejal Lathia,5 Jubbin Jagan Jacob,6 Sunil Kumar Kota,7 Saptrishi Bhattacharya,8 Sharvil S Gadve,9 KAV Subramanium,10 Joe George,11 Vageesh Iyer,12 Sujit Chandratreya,13 Pankaj Kumar Aggrawal,14 Shailendra Kumar Singh,15 Ameya Joshi,16 Chitra Selvan,17 Gagan Priya,18 Atul Dhingra,19 Sambit Das20 1Department of Endocrinology, Gujarat Endocrine Centre, Ahmedabad, Gujarat, India; 2Department of Endocrinology, Bharti Hospital & B.R.I.D.E, Karnal, Haryana, India; 3Department of Endocrinology, MAX Super Specialty Hospital, Dehradun, Uttarakhand, India; 4Department of Endocrinology, Apollo Hospital & Dispur Polyclinic and Nursing Home, Guwahati, West Bengal, India; 5Department of Endocrinology, Apollo Hospital, Mumbai, Maharashtra, India; 6Department of Endocrinology, CMC Hospital, Ludhiana, Punjab, India; 7Department of Endocrinology, Diabetes and Endocrine Clinic, Berhampur, Orissa, India; 8Department of Endocrinology, OeHealth Diabates & Endocrinology Centre, Delhi, Delhi, India; 9Department of Endocrinology, Excel Endocrine Centre, Kolhapur, Maharashtra, India; 10Department of Endocrinology, Visakha Diabates & Endocrine Centre, Vishakhapatnam, Andhra Pradesh, India; 11Department of Endocrinology, Endodiab Clinic, Calicut, Kerala, India; 12Department of Endocrinology, St.Johnâs Medical College & Hospital, Bangalore, Karnataka, India; 13Department of Endocrinology, Endocare Clinic, Nashik, Maharashtra, India; 14Department of Endocrinology, Hormone Care & Research Centre, Ghaziabad, Uttar Pradesh, India; 15Department of Endocrinology, Endocrine Clinic, Varanasi, Uttar Pradesh, India; 16Department of Endocrinology, Endocrine and Diabetes Clinic, Mumbai, Maharashtra, India; 17Department of Endocrinology, Ramaiah Memorial Hospital, Bangalore, Karnataka, India; 18Department of Endocrinology, IVY Hospital, Chandigarh, Punjab, India; 19Department of Endocrinology, Bansal Hospital, Sri Ganganagar, Rajasthan, India; 20Department of Endocrinology, Endeavour Clinic, Bhubaneshwar, Orissa, IndiaCorrespondence: Sanjay Kalra, Kunjpura Road, Model Town, Near State Bank of India, Sector 12, Karnal, Haryana, 132001, India, Tel +9215848555, Email brideknl@gmail.comAbstract: Glucocorticoids are potent immunosuppressive and anti-inflammatory drugs used for various systemic and localized conditions. The use of glucocorticoids needs to be weighed against their adverse effect of aggravating hyperglycemia in persons with diabetes mellitus, unmask undiagnosed diabetes mellitus, or precipitate glucocorticoid-induced diabetes mellitus appearance. Hyperglycemia is associated with poor clinical outcomes, including infection, disability after hospital discharge, prolonged hospital stay, and death. Furthermore, clear guidelines for managing glucocorticoid-induced hyperglycemia are lacking. Therefore, this consensus document aims to develop guidance on the management of glucocorticoid-induced hyperglycemia. Twenty expert endocrinologists, in a virtual meeting, discussed the evidence and practical experience of real-life management of glucocorticoid-induced hyperglycemia. The expert group concluded that we should be proactive in terms of diagnosis, management, and post-steroid care. Since every patient has different severity of underlying disease, clinical stratification would help understand patient profiles and determine the treatment course. Patients at home with pre-existing diabetes who are already on oral or injectable therapy can continue the same as long as they are clinically stable and eating adequately. However, depending on the degree of hyperglycemia, modification of doses may be required. Initiating basal bolus with correction regimen is recommended for patients in non-intensive care unit settings. For patients in intensive care unit, variable rate intravenous insulin infusion could be temporarily used, but under supervision of diabetes inpatient team, and patients can be transitioned to subcutaneous insulin once stable baseline assessment and continual evaluation are crucial for day-to-day decisions concerning insulin doses. Glycemic variability should be carefully monitored, and interventions to treat patients should also aim at achieving and maintaining euglycemia. Rational use of glucose-lowering drugs is recommended and treatment regimen should ensure maximum safety for both patient and provider. Glucovigilance is required as the steroids taper during transition, and insulin dosage should be reduced subsequently. Increased clinical and economic burden resulting from corticosteroid-related adverse events highlights the need for effective management. Therefore, these recommendations would help successfully manage GC-induced hyperglycemia and judiciously allocate resources.Keywords: corticosteroids, insulin, steroid-induced hyperglycemia, steroid-induced diabetes, stress hyperglycemia, diabetes |
