Management of Hyperglycemia in Diabetic Patients with Hematologic Malignancies During Dexamethasone Therapy |
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| Institution: | 1. Department of Medicine, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, Tennessee;2. Boston Baskin Cancer Foundation, Memphis;3. Methodist University Hospital, Memphis;4. Rollins School of Public Health and Emory University, Atlanta;5. Department of Medicine, Division of Endocrinology, Emory University, Atlanta;1. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;2. Department of Nutrition Sciences, Ariel University, Ariel, Israel;3. Department of Surgery “A”, Edith Wolfson Medical Center, Holon, Israel;4. Diabetes Unit, Edith Wolfson Medical Center, Holon, Israel;5. Department of Internal Medicine “A”, Yoseftal Hospital, Eilat, Israel;1. Departments of Endocrinology and Laboratory Medicine, Lahey Clinic Medical Center, Burlington, Massachusetts, Tufts University School of Medicine;2. Departments of Biochemistry and Urology, Boston University School of Medicine, Boston, Massachusetts;3. Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts |
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| Abstract: | ObjectiveTo compare the response to different insulin regimens for management of hyperglycemia in diabetic patients with hematologic malignancies who are receiving dexamethasone.MethodsA retrospective analysis was conducted to determine whether a basal bolus insulin (BBI) regimen with detemir and aspart is superior to a sliding scale regular insulin (SSI) regimen for management of hyperglycemia in hospitalized diabetic patients receiving dexamethasone.ResultsForty patients with hematologic malignancies were treated with intravenous (8 to 12 mg/day) or oral (40 mg/day) dexamethasone for 3 days. The average blood glucose (BG) level was 301 ± 57 mg/dL in the SSI group (n = 28) and 219 ± 51 mg/dL in the BBI group (n = 12) (P <.001). The BBI regimen resulted in an average BG reduction of 52 ± 82 mg/dL throughout the course of dexa-methasone therapy, while the SSI regimen produced an increase in the mean daily BG level of 128 ± 77 mg/dL (P <.001). On the last day of dexamethasone administration, the insulin requirement was 49 ± 29 units/day in the SSI group and 122 ± 39 units/day in the BBI group (P <.001). Three patients in the SSI group developed diabetic ketoacidosis or hyperosmolar hyperglycemia during steroid therapy. No hypoglycemia was observed in either group. The length of stay and infection rates were similar between groups.ConclusionBasal and bolus insulin regimen is an effective and safe approach for managing dexamethasone-induced hyperglycemia in hospitalized patients with hematologic malignancies. (Endocr Pract. 2013;19:231-235) |
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