Diabetes management during glucocorticoid therapy for nonendocrine disease

Abstract

Objective: To determine current attitudes about management of diabetes during glucocorticoid therapy for nonendocrine disease, as assessed by a pilot survey.

Methods: A 27-item questionnaire was designed to determine areas of consensus and of disagreement on diabetes management during glucocorticoid therapy for nonendocrine disease and was mailed to 84 Chicago-area academic general internists, endocrinologists, pulmonologists or allergists, rheumatologists, and certified diabetes nurse-educators.

Results: The response rate was 55%. For new-onset "steroid diabetes," 43% of respondents agreed with use of insulin and 44% with use of sulfonylurea therapy. Respondents indicated 91 to 95% agreement on the desirability of self-monitoring of blood glucose on initiation of glucocorticoid therapy. For a fasting plasma venous glucose level of 150 mg/dL at the time of initiation of long-term glucocorticoid therapy, 54% of respondents disagreed with immediate increase of insulin in the case of a patient already taking insulin, and 80% disagreed with immediate substitution of insulin in the case of a patient on maximal glyburide therapy (P = 0.0053 for mean change of position). During tapering of glucocorticoid therapy, 75% of respondents approved close observation without immediate insulin reduction. Two anticipatory management plans, opposed by 54% and 45% of respondents, respectively, elicited strongly correlated attitudes: immediate increase of NPH insulin dosage during initiation of glucocorticoid therapy and immediate reduction of NPH insulin dose during tapering of glucocorticoids (r = 0.6296; P<0.0001). Finally, 78% perceived a paucity of objective information about diabetes management during glucocorticoid therapy for nonendocrine disease.

Conclusion: The surveyed sample of practitioners reported a paucity of objective data about management of diabetes during glucocorticoid therapy for nonendocrine disease and conservatism in adjusting diabetes management during initiation and tapering of glucocorticoid therapy.