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      Are they high on steroids? Tailored interventions help improve screening for steroid-induced hyperglycaemia in hospitalised patients

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          Abstract

          Steroid-induced hyperglycaemia (SIH) is a common adverse effect in patients both with and without diabetes. This project aimed to improve the screening and diagnosis of SIH by improving the knowledge of healthcare professionals who contribute to the management of SIH in hospitalised patients. Monitoring and diagnosis of SIH were measured in areas of high steroid use in our hospital from May 2016 to January 2017. Several interventions were implemented to improve knowledge and screening for SIH including a staff education programme for nurses, healthcare assistants and doctors. The Trust guidelines for SIH management were updated based on feedback from staff. The changes to the guideline included shortening the document from 14 to 4 pages, incorporating a flowchart summarising the management of SIH and publishing the guideline on the Trust intranet. A questionnaire based on the recommendations of the Joint British Diabetes Societies for SIH was used to assess the change in knowledge pre-intervention and post-intervention. Results showed an increase in junior doctors’ knowledge of this topic. Although there was an initial improvement in screening for SIH, this returned to near baseline by the end of the study. This study highlights that screening for SIH can be improved by increasing the knowledge of healthcare staff. However, there is a need for ongoing interventions to sustain this change.

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          Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review.

          Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. In the present review, we discuss the main epidemiologic characteristics associated with steroid use, with emphasis on the identification of high risk populations. Additionally we present the pathophysiology of corticosteroid induced hyperglycemia as well as the pharmacokinetics and pharmacodynamics associated with steroid use. We propose a treatment strategy based on previous reports and the understanding of the mechanism of action of both, the different types of glucocorticoids and the treatment options, in both the ambulatory and the hospital setting. Finally, we present some of the recent scientific advances as well as some options for future use of glucocorticoids.
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            Prevalence and predictors of corticosteroid-related hyperglycemia in hospitalized patients.

            To investigate the prevalence of and risk factors for hyperglycemia in hospitalized patients receiving corticosteroids, which have been identified as an independent predictor of hyperglycemia. We conducted a retrospective review of electronic medical records of patients admitted to the general medicine service at a university hospital during a 1-month period. Pharmacy charges were used to identify patients receiving high doses (> or = 40 mg/day of prednisone or the equivalent) of corticosteroids for at least 2 days. Occurrence of hyperglycemia and the presence of risk factors, including history of diabetes, duration of corticosteroid therapy, concurrent parenteral nutrition, antibiotic therapy, use of medications associated with hyperglycemia, severity of illness scores, and hospital length of stay, were determined. Patients experiencing multiple episodes of hyperglycemia (glucose levels > or = 200 mg/dL) were compared with those who had < or = 1 hyperglycemic episode. Patients without a history of diabetes were assessed separately. During the 1-month study period, 66 of 617 patients received high doses of corticosteroids, but only 50 of the 66 had glucose measurements. Hyperglycemia was documented in 32 of these 50 patients (64%), and multiple hyperglycemic episodes occurred in 26 (52%). A history of diabetes was documented in 12 of 26 patients who experienced multiple episodes, in comparison with 4 of 24 patients with < or = 1 episode of hyperglycemia (P = 0.035). Among patients without a history of diabetes, 19 of 34 (56%) had hyperglycemia at least once. Patients with multiple episodes of hyperglycemia had more comorbid diseases, longer duration of corticosteroid therapy, and longer duration of hospital stay. Hyperglycemia occurs in a majority of hospitalized patients receiving high doses of corticosteroids. In light of the poor outcomes associated with hyperglycemia, protocols targeting its detection and management should be available for patients who receive corticosteroid therapy.
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              The high incidence of steroid-induced hyperglycaemia in hospital.

              The objective of this study was to systematically evaluate the incidence of steroid-induced hyperglycaemia in a tertiary referral hospital. We conducted a glucometric audit of a prospective protocol where glucose monitoring was routinely performed on patients treated with high-dose steroids.
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                Author and article information

                Journal
                BMJ Open Qual
                BMJ Open Qual
                bmjqir
                bmjoq
                BMJ Open Quality
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2399-6641
                2018
                14 March 2018
                : 7
                : 1
                : e000238
                Affiliations
                [1 ]departmentDepartment of Diabetes, Endocrinology and General Internal Medicine , Heart of England NHS Foundation Trust , Birmingham, UK
                [2 ]departmentDepartment of Diabetes , University Hospital Birmingham NHS Foundation Trust , Birmingham, UK
                [3 ]departmentMedical School , University of Birmingham , Birmingham, UK
                [4 ]departmentDepartment of Health Informatics , Queen Elizabeth Hospital Birmingham , Birmingham, UK
                [10 ]departmentInstitute of Metabolism and Systems Research , University of Birmingham , Birmingham, United Kingdom
                Author notes
                [Correspondence to ] Dr Punith Kempegowda; p.kempegowda@ 123456nhs.net
                Author information
                http://orcid.org/0000-0003-0954-6512
                http://orcid.org/0000-0002-1174-0587
                http://orcid.org/0000-0002-9561-5141
                Article
                bmjoq-2017-000238
                10.1136/bmjoq-2017-000238
                5878254
                1de9eae1-6dfa-40b2-a6d6-85cec012d2dc
                © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 26 October 2017
                : 28 December 2017
                : 24 January 2018
                Categories
                Original Article
                1506
                Custom metadata
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                healthcare quality improvement,health professions education,patient-centred care,quality improvement,team training

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