Glucocorticoid-induced hyperglycaemia in hospitalised adults: A matched cohort study (2013-2023)

To compare the risk of new-onset hyperglycaemia between inpatients treated versus non-treated with systemic glucocorticoids and identify factors associated with glucocorticoid-induced hyperglycaemia (GIH).

We conducted a cohort study using electronic healthcare records of adults admitted to the Oxford University Hospitals between 2013 and 2023. We excluded patients with diabetes or prescribed systemic glucocorticoids before admission. The outcome was new-onset hyperglycaemia defined as a new glucose-lowering therapy, coded diagnosis of diabetes or random blood glucose ≥11.1 mmol/L. We used Poisson regression to estimate the incidence rate ratio (IRR) of new-onset hyperglycaemia during periods of exposure versus non-exposure to systemic glucocorticoids, adjusting for confounders. We used Poisson regression models to identify potential risk factors for GIH.

Of 451 606 included patients, 17 258 (3.8%) received systemic glucocorticoids during admission. Totally 316 (1.8%) of patients exposed to systemic glucocorticoids developed new-onset hyperglycaemia versus 3430 (0.8%) non-exposed to systemic glucocorticoids. The multivariable-adjusted IRR (95% CI) for new-onset hyperglycaemia among exposed versus non-exposed was 2.15 (1.18-3.12). Covariates associated with GIH were: age (relative risk, 95% CI) 1.02 (1.01-1.03) per year, ethnicity (1.72 [1.04-2.86] Asian vs. White, 1.26 [1.05-2.70] other vs. White), weight 1.01 (1.01-1.03) per kg, indication (2.15 [1.21-3.52] autoimmune/inflammatory/infection vs. malignant, 2.11 [1.18-4.20] other vs. malignant) and cumulative glucocorticoid dose (1.23 [1.04-1.42], for 51-205 mg vs. >0-50 mg and 2.53 [1.89-3.40] for > 205 mg vs. >0-50 mg).

Treatment with systemic glucocorticoids versus no glucocorticoid treatment during hospitalisation more than doubles the risk of new-onset hyperglycaemia. Higher age, weight, cumulative glucocorticoid dose, non-White ethnicity and autoimmune/inflammatory conditions were independently associated with a higher risk of GIH.