Continuous Glucose Monitoring Profiles in Children Receiving High-Dose Glucocorticoid Treatment

Glucocorticoids (GCs) remain the first-line treatment for many autoimmune, inflammatory, and allergic conditions, but the prevalence of GC-induced hyperglycemia (GIH) in pediatric individuals has not been established. Furthermore, there are currently no universal recommendations regarding the timing and frequency of glucose monitoring during high-dose GC therapy. Our objective was to describe the glycemic patterns in children receiving high doses of systemic GCs using continuous glucose monitoring (CGM) and to describe the risk factors for GIH.

This prospective observational study with retrospective analysis of blinded CGM data was performed between December 2021 and December 2024 at the Department of Paediatrics of the Tartu University Children's Clinic. Participants who received GC treatment due to an underlying condition at a dose of at least 1 mg/kg/day prednisolone-equivalent were monitored with an iPro 2 or a Guardian Connect CGM system during their GC treatment course. CGM data were analyzed retrospectively. The following parameters were evaluated: time in range (percentage of readings in the range 3.9-10 mmol/L), time above range (TAR, percentage of readings above 10 mmol/L), time below range (percentage of readings below 3.9 mmol/L), mean sensor glucose (SG) and glycemic variability.

CGM profiles of 10 participants were analyzed (2 boys and 8 girls). The average age of the participants was 10.5 years (range from 4 to 17 years). The average duration of glucose monitoring with CGM was 5 days (±2 days). Seven out of ten children experienced GIH, defined as SG above 10 mmol/L. The average coefficient of variation of the participants was 21% (range from 15 to 26%). Individuals with GIH spent on average 1.5 h per day with glucose values above 10 mmol/L, which attributes to TAR of 6% (±9%). The highest SG values during 24 h were observed between 16:00 and 23:00 for participants receiving oral prednisolone and intravenous methylprednisolone.

Two-thirds of investigated subjects developed GC-induced hyperglycemia. Participants experienced episodes of hyperglycemia regardless of the route of GC administration. The highest glucose values during 24 h were observed between 16:00 and 23:00 for patients receiving oral prednisolone and intravenous methylprednisolone. This observation is relevant to the optimal timing of screening for GC-induced hyperglycemia.