Treatment of glucocorticoid- induced hyperglycemia in hospitalized patients - a systematic review and meta- analysis
Abstract Purpose Glucocorticoid (GC)-induced hyperglycemia is a frequent issue, however there are no specific guidelines for this diabetes subtype. Although treat-to-target insulin is recommended in general to correct hyperglycemia, it remains unclear which treatment strategy has a positive effect o...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Clinical Diabetes and Endocrinology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40842-023-00158-1 |
| _version_ | 1797276337446060032 |
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| author | Tristan Struja Neele Nitritz Islay Alexander Kevin Kupferschmid Jason F. Hafner Carlos C. Spagnuolo Philipp Schuetz Beat Mueller Claudine A. Blum |
| author_facet | Tristan Struja Neele Nitritz Islay Alexander Kevin Kupferschmid Jason F. Hafner Carlos C. Spagnuolo Philipp Schuetz Beat Mueller Claudine A. Blum |
| author_sort | Tristan Struja |
| collection | DOAJ |
| description | Abstract Purpose Glucocorticoid (GC)-induced hyperglycemia is a frequent issue, however there are no specific guidelines for this diabetes subtype. Although treat-to-target insulin is recommended in general to correct hyperglycemia, it remains unclear which treatment strategy has a positive effect on outcomes. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess whether treating GC-induced hyperglycemia improves clinical outcomes. Methods MEDLINE and EMBASE were systematically searched for RCTs on adults reporting treatment and outcomes of GC-induced hyperglycemia since the beginning of the data bases until October 21, 2023. Glucose-lowering strategies as compared to usual care were investigated. Results We found 17 RCTs with 808 patients and included seven trials in the quantitative analysis. Patients with an intensive glucose-lowering strategy had lower standardized mean glucose levels of – 0.29 mmol/l (95%CI -0.64 to -0.05) compared to usual care group patients. There was no increase in hypoglycemic events in the intensively treated groups (RR 0.91, 95%CI 0.70–1.17). Overall, we did not have enough trials reporting clinical outcomes for a quantitative analysis with only one trial reporting mortality. Conclusion In GC-induced hyperglycemia, tight glucose control has a moderate effect on mean glucose levels with no apparent harmful effect regarding hypoglycemia. There is insufficient data whether insulin treatment improves clinical outcomes, and data on non-insulin based treatment regimens are currently too sparse to draw any conclusions. Systematic review registration Registered as CRD42020147409 at PROSPERO ( https://www.crd.york.ac.uk/prospero/ ) on April 28, 2020 |
| first_indexed | 2024-03-07T15:26:50Z |
| format | Article |
| id | doaj.art-7cef57bc16cf431e87902ea614e52470 |
| institution | Directory Open Access Journal |
| issn | 2055-8260 |
| language | English |
| last_indexed | 2024-03-07T15:26:50Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Clinical Diabetes and Endocrinology |
| spelling | doaj.art-7cef57bc16cf431e87902ea614e524702024-03-05T16:38:55ZengBMCClinical Diabetes and Endocrinology2055-82602024-01-0110111410.1186/s40842-023-00158-1Treatment of glucocorticoid- induced hyperglycemia in hospitalized patients - a systematic review and meta- analysisTristan Struja0Neele Nitritz1Islay Alexander2Kevin Kupferschmid3Jason F. Hafner4Carlos C. Spagnuolo5Philipp Schuetz6Beat Mueller7Claudine A. Blum8Department of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital AarauDepartment of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital AarauDepartment of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital AarauDepartment of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital AarauDepartment of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital AarauDepartment of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital AarauDepartment of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital AarauDepartment of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital AarauDepartment of General Internal and Emergency Medicine, Department of Endocrinology, Diabetology and Metabolism, Medical University Clinic (University of Basel), Kantonsspital AarauAbstract Purpose Glucocorticoid (GC)-induced hyperglycemia is a frequent issue, however there are no specific guidelines for this diabetes subtype. Although treat-to-target insulin is recommended in general to correct hyperglycemia, it remains unclear which treatment strategy has a positive effect on outcomes. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess whether treating GC-induced hyperglycemia improves clinical outcomes. Methods MEDLINE and EMBASE were systematically searched for RCTs on adults reporting treatment and outcomes of GC-induced hyperglycemia since the beginning of the data bases until October 21, 2023. Glucose-lowering strategies as compared to usual care were investigated. Results We found 17 RCTs with 808 patients and included seven trials in the quantitative analysis. Patients with an intensive glucose-lowering strategy had lower standardized mean glucose levels of – 0.29 mmol/l (95%CI -0.64 to -0.05) compared to usual care group patients. There was no increase in hypoglycemic events in the intensively treated groups (RR 0.91, 95%CI 0.70–1.17). Overall, we did not have enough trials reporting clinical outcomes for a quantitative analysis with only one trial reporting mortality. Conclusion In GC-induced hyperglycemia, tight glucose control has a moderate effect on mean glucose levels with no apparent harmful effect regarding hypoglycemia. There is insufficient data whether insulin treatment improves clinical outcomes, and data on non-insulin based treatment regimens are currently too sparse to draw any conclusions. Systematic review registration Registered as CRD42020147409 at PROSPERO ( https://www.crd.york.ac.uk/prospero/ ) on April 28, 2020https://doi.org/10.1186/s40842-023-00158-1Glucocorticoid-induced DiabetesGlucocorticoidsHyperglycemiaHypoglycemic agentsInsulin |
| spellingShingle | Tristan Struja Neele Nitritz Islay Alexander Kevin Kupferschmid Jason F. Hafner Carlos C. Spagnuolo Philipp Schuetz Beat Mueller Claudine A. Blum Treatment of glucocorticoid- induced hyperglycemia in hospitalized patients - a systematic review and meta- analysis Clinical Diabetes and Endocrinology Glucocorticoid-induced Diabetes Glucocorticoids Hyperglycemia Hypoglycemic agents Insulin |
| title | Treatment of glucocorticoid- induced hyperglycemia in hospitalized patients - a systematic review and meta- analysis |
| title_full | Treatment of glucocorticoid- induced hyperglycemia in hospitalized patients - a systematic review and meta- analysis |
| title_fullStr | Treatment of glucocorticoid- induced hyperglycemia in hospitalized patients - a systematic review and meta- analysis |
| title_full_unstemmed | Treatment of glucocorticoid- induced hyperglycemia in hospitalized patients - a systematic review and meta- analysis |
| title_short | Treatment of glucocorticoid- induced hyperglycemia in hospitalized patients - a systematic review and meta- analysis |
| title_sort | treatment of glucocorticoid induced hyperglycemia in hospitalized patients a systematic review and meta analysis |
| topic | Glucocorticoid-induced Diabetes Glucocorticoids Hyperglycemia Hypoglycemic agents Insulin |
| url | https://doi.org/10.1186/s40842-023-00158-1 |
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