Glucocorticoid-Induced Hyperglycaemia in Hospital: The Insulin Dose Matters Most

Prescription of glucocorticoids in hospital is a common cause of new onset hyperglycaemia, which is associated with increased mortality and morbidity. However, to date studies have not defined optimal treatment of hyperglycaemia associated with glucocorticoids and this is reflected in clinical guidelines. We recently reported the large range in the daily insulin dose requirements in hospitalized patients prescribed glucocorticoids. Failure to rapidly and accurately approximate the required insulin dose is a likely explanation for the suboptimal glycaemic control commonly reported in glucocorticoid-treated patients. Body weight is usually used to calculate insulin doses; while it is associated with the calculated daily insulin dose in patients on glucocorticoids, it only explains a small proportion of dosing variance. However, other clinical factors, such as sex, presence or absence of known diabetes, glucose-lowering treatment before hospital admission and glycosylated haemoglobin are also associated with the insulin dose requirements in patients with hyperglycaemia on glucocorticoids. We hypothesize that incorporation of additional clinical factors into insulin dosing calculations could potentially facilitate individualized treatment and improve outcomes for hospitalized patients with hyperglycaemia while prescribed glucocorticoids.