- Achieving effective glycemic control in patients with type 2 diabetes (T2D) initiating systemic glucocorticoid therapy is difficult.
- Obstacles include heterogeneity of populations, interventions, target glucose levels, and glucose monitoring in available studies, and low-moderate quality of evidence.
- Even for the widely recommended basal-bolus insulin (BBI) regimens, data are inconclusive.
Why this matters
- Steroid treatment in patients with diabetes is common, but often leads to or exacerbates hyperglycemia.
- Systematic literature review yielded 8 articles reporting studies including 481 individuals (343 with diabetes, 138 with glucocorticoid-induced hyperglycemia).
- Funding: None.
- In 6 studies of BBI regimens, divergence in designs (i.e., in use of sliding-scale insulin [SSI] regimens, intermediate- vs long-acting insulin, and dosing) “precluded a clean and coherent quantitative meta-analysis.”
- In 3 trials comparing NPH with glargine in BBI regimens, overall glycemic control did not differ significantly between them.
- In 1 study comparing addition of SSI or intermediate-acting insulin (IMI) to established diabetes medication, IMI produced greater time in target glucose range (P<.001 and lower mean daily glucose>
- No studies compared anticipatory vs compensatory adjustments.
- Low-moderate evidence quality.
- Lack of comparability.
- Inclusion of populations with type 1 diabetes, and T2D with and without baseline insulin treatment.