STEROID-INDUCED DYSGLYCAEMIA DURING FIRST 48 HOURS OF STEROID THERAPY IN HOSPITALISED PATIENTS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2017, Vol 6, Issue 89
Abstract
BACKGROUND Glucocorticoid (GC) is crucial for glucose, lipid and protein metabolism and therefore for energy balance. GCs are used in treatment of chronic obstructive pulmonary disease (COPD) exacerbations, a clinical manifestation of an acute-on-chronic inflammatory process in the airways, often with systemic spill over. In spite of their enormous useful actions, usage of corticosteroid is under limitation in view of its side effect profile, which in turn is dependent on amount of drug and duration for which the drug was administered for the sake of treatment. The combination of hypertension, central obesity and glucose intolerance is called as `Reaven's Syndrome X’ or the ‘Metabolic Syndrome’. The most common adverse effect following steroid therapy is the development of (dys) hyperglycaemia. Avoidance of hypoglycaemia is important because it has been implicated as a potential cause of increased mortality in patients receiving intensive insulin therapy. A better understanding of the glycaemic effect of prednisolone will allow the development of a specific treatment strategy for prednisolone-induced hyperglycaemia that targets the time of day during which hyperglycaemia predominates. MATERIALS AND METHODS The study is a descriptive study. Study Period- 6 months. Study Area- Govt. Royapettah Hospital attached to Govt. Kilpauk Medical College. RESULTS In my study, it is found that there is rise in capillary blood glucose level after administration of steroid during all the three different times (6, 12 & 48 hours) and with respect to all the three different drugs given to the patient for their exacerbation. Thus the occurrence of hyperglycaemia within 48 hours in patients started on corticosteroid therapy is proven. The Capillary Blood Glucose level after administration of the drug is highest at 191.47 with Hydrocortisone > 162.47 with Dexamethasone > 152.42 with Prednisolone. So, the risk of (dys) hyperglycaemia is highest with Hydrocortisone (short acting) when compared with other two drugs (long acting). Thus, steroid-induced hyperglycaemia is more with parenteral steroids than oral forms. The Capillary Blood Glucose peaks at the 12th hour after administration of any of the three drugs namely Dexamethasone, Hydrocortisone & Prednisolone. HbA1c & Systolic BP has significant correlation for Dexamethasone. Systolic BP & Waist Circumference has significant correlation for Hydrocortisone. HbA1c & Waist Circumference has significant correlation for Prednisolone. CONCLUSION The short-acting steroid Hydrocortisone with highest rise in CBG at all three times after its administration is to be avoided unless the clinical condition demands. Oral Prednisolone is comparatively a safer drug with less side effect (hyperglycaemia) profile and ease of administration.
Authors and Affiliations
Venkateswarlu Dhirisala, Hariharan Chellapandy, Sailendri Ganapathy
Keywords
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- EP ID EP277976
- DOI 10.14260/jemds/2017/1359
- Views 55
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