An audit of inpatient dermatology admissions: Management of hyperglycaemia in oral glucocorticoid use

Oral glucocorticoids are used to treat a variety of dermatological conditions with high doses often used initially to gain control of disease. The side effect profile of glucocorticoids is widely documented and manifest in the short and long term period. Hyperglycaemia is a well-known side effect can result from short and long term administration of systemic glucocorticoids. Currently there is no published data or established guidelines on the management of glucocorticoid-induced hyperglycaemia in the Dermatology setting. We performed an audit of inpatient Dermatology admissions at St Vincent's Hospital in Melbourne over a 2 year period between January 2014 and December 2015 with a particular focus on glycaemic control in patients who were treated with systemic glucocorticoids. Information on patient characteristics, dermatologic diagnoses and medical comorbidities was also collected. There were a total of 131 admissions to the Dermatology inpatient unit over a 2 year period. The most common diagnoses included eczema/dermatitis, psoriasis and chronic ulcers. Forty-five percent of inpatients were treated with oral prednisolone with a mean highest dose of 34mg. Over 30% of inpatients on oral prednisolone developed hyperglycaemia. We found that inpatients on oral prednisolone also had inconsistent blood glucose level testing. As a result of this audit, we propose a management plan for glucocorticoid-induced hyperglycaemia which involves acute and long term management to avoid the complications of hyperglycaemia for Dermatology patients treated with oral glucocorticoids.

Dr. Chasari Toy Tancharoen