Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Apr;51(4):296-304.
doi: 10.1310/hpj5104-296.

Evaluation of the Impact of Corticosteroid Dose on the Incidence of Hyperglycemia in Hospitalized Patients With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Free PMC article

Evaluation of the Impact of Corticosteroid Dose on the Incidence of Hyperglycemia in Hospitalized Patients With an Acute Exacerbation of Chronic Obstructive Pulmonary Disease

James M Baker et al. Hosp Pharm. .
Free PMC article

Abstract

Purpose: Guidelines recommend systemic corticosteroids for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) albeit in lower doses than studies that cemented corticosteroids' place in therapy. Corticosteroids potentiate hyperglycemia, however it is undetermined how corticosteroid dose impacts hyperglycemia incidence.

Objectives: To establish whether a greater incidence of steroid-induced hyperglycemia (SIHGLY) exists for high- versus low-dose corticosteroids.

Methods: Patients with primary discharge diagnosis 491.21/491.22 in a community hospital were retrospectively reviewed and divided into tertiles based on corticosteroid dosage. Baseline characteristics and primary endpoint were statistically assessed between tertiles using logistic regression analysis. A Cox proportional hazards (CPH) model adjusted for potential covariates. Post hoc analysis for primary outcome and CPH model was run removing non-insulin dependent diabetics because of disproportionate event count. A secondary endpoint used a Kaplan-Meier curve to evaluate time to event between tertiles.

Results: Tertile divisions were 125 and 187.5 mg methylprednisolone equivalents. The primary outcome for incidence of SIHGLY was insignificant; post hoc analysis removing non-insulin-dependent diabetics narrowly missed significance between tertiles 1 and 3 (P = .056). CPH analysis found significant differences in SIHGLY between tertiles 1 and 2 (hazard ratio [HR], 1.68; 95% CI, 1.02-2.76) and tertile 1 and 3 (HR, 1.79; 95% CI, 1.13-2.84), further post hoc analysis resulted in a loss of significance for the CPH analysis. Of 21 non-insulin-dependent diabetics, 20 met event status. The Kaplan-Meier analysis results were insignificant.

Conclusions: Study results suggest that a link between larger corticosteroid doses and hyperglycemia incidence may exist, but it requires further study. RESULTS in non-insulin-dependent diabetics provide evidence for increased glucose monitoring upon initiation of corticosteroid therapy.

Figures

Figure 1.
Figure 1.
Kaplan-Meier curve showing the time to event analysis. Censored denotes patients no longer available for follow-up who did not experience an event. No statistical comparisons reached significance (P > .05) for the Kaplan-Meier curve analysis.
Figure 2.
Figure 2.
Cox proportional hazards model adjusting for predetermined covariates. Both the low to moderate dose (hazard ratio [HR], 1.68; 95% CI, 1.02–2.76) and low to high dose (HR, 1.79; 95% CI, 1.13–2.84)) comparisons achieved significance.

Similar articles

See all similar articles

Cited by 3 articles

Feedback