Category: Professional Posters
Purpose: Corticosteroid use has been reported in approximately 12% of hospitalized patients with hyperglycemia being a significant complication, particularly at high doses. Basal-bolus insulin regimens are well-established for the treatment of corticosteroid-induced hyperglycemia in the inpatient setting. Corticosteroids primarily raise post-prandial blood glucose levels with minimal effect on fasting blood glucose. Since routine inpatient glucose monitoring consists of fasting blood glucose, corticosteroid-induced hyperglycemia can go unnoticed and untreated in this setting. The purpose of this study is to evaluate pharmacist impact on serial blood glucose monitoring and treatment in patients with corticosteroid-induced hyperglycemia in the inpatient setting.
Methods: This was a single-center, IRB-approved, bi-phasic study of adult patients receiving high doses of steroids (greater than or equal to prednisone 30 mg/day or its equivalent). Phase I was a retrospective chart review of 50 patients from July 2018 to September 2018. Phase II was a prospective review of 49 patients from February 2019 to April 2019. In phase II, patients were followed daily by a pharmacist and reviewed for the presence of point-of-care blood glucose monitoring and for the onset of hyperglycemia (point-of-care blood glucose level 180 mg/dL or greater). If two consecutive point-of-care blood glucose values were greater than or equal to 180 mg/dL, the pharmacist intervened to initiate or adjust insulin therapy in accordance with the hospital insulin protocol. The primary endpoints included incidence of point-of-care blood glucose monitoring, incidence of hyperglycemia, and average point-of-care blood glucose levels. Secondary endpoints included presence of common risk factors for corticosteroid-induced hyperglycemia and number of pharmacy interventions accepted in phase II. Descriptive and comparative statistics were utilized in the data analysis.
Results: A total of 50 patients were included in phase I of the study while 49 patients were included during phase II. The incidence of overall point-of-care blood glucose monitoring increased from 36% of patients to 88% of patients (p<0.05). Diabetic patients were more likely to have point-of-care blood glucose levels monitored in both phases. However, a large increase in monitoring (9% to 83%) was noted from phase I to phase II in non-diabetic patients. The average point-of-care blood glucose levels decreased from 206 mg/dL in phase I to 182 mg/dL in phase II (p=3.66). The incidence of hyperglycemia decreased from 74% to 53% (p<0.05). The most commonly identified risk factors for corticosteroid-induced hyperglycemia were age greater than 65 years and body mass index greater than 25 kilograms per meters squared. In the prospective interventional phase, a total of 48 pharmacy-initiated interventions were made, of which 38 (79%) were accepted by the physician. As a safety outcome, the incidence of hypoglycemia was assessed. The incidence of hypoglycemia was 1.1% in phase I vs. 0.9% in phase II (p=0.5249)
Conclusion: Pharmacist intervention had a significant impact on increasing point-of-care blood glucose monitoring and improving glycemic control by reducing hyperglycemia incidence in patients on high doses of corticosteroids at risk for corticosteroid-induced hyperglycemia. This study serves as justification to propose a collaborative practice agreement that would allow the automatic ordering of point-of-care blood glucose monitoring in patients who meet specific criteria. This would allow clinicians to have blood glucose values available in the patient’s chart to identify when hyperglycemia management is warranted.