Differential effects of oral versus intravenous hydrocortisone and dexamethasone on capillary blood glucose levels in adult inpatients - a single centre study.

IF 3.6 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL Clinical Medicine Pub Date : 2024-10-04 DOI:10.1016/j.clinme.2024.100249
Vaishali Limbachia, Ian Nunney, Daniel J Page, Hannah A Barton, Leena K Patel, Georgia N Thomason, Stephan L Green, Kieran F J Lewis, Ketan Dhatariya
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Abstract

Background: Corticosteroids raise blood glucose concentrations; however, it remains unknown which form of administration, oral or intravenous, is associated with the greatest degree of blood glucose rise in hospitalised patients. Furthermore, it is not known whether the pattern of the associated hyperglycaemia throughout the day differs depending on the route of administration.

Methods: This was a single centre retrospective study of 384 adult inpatients receiving oral or intravenous hydrocortisone and dexamethasone. Data on capillary glucose concentrations and time taken over 7 days were collected. A mixed model for repeated measures was applied to compare changes in glucose concentration over time for oral and intravenous corticosteroids. An auto-regressive covariance structure was employed to model correlations between repeated measurements. This was adjusted for age, sex, pre-admission diabetes, and/or pre-admission corticosteroid status.

Results: No significant difference was found between oral and intravenous hydrocortisone on day 1 or across all 7 days (mean difference 0.17 mmol/L (-1.39, 1.75), p = 0.827, and mean difference 0.20 mmol/L (-0.61, 1.01), p = 0.639 respectively). There were no differences in mean glucose concentrations between those on oral or intravenous dexamethasone on day 1 or across all 7 days (mean difference 0.41 mmol/L (-0.55, 1.38), p = 0.404 and mean difference -0.09 mmol/L (-1.05,0.87), p = 0.855, respectively).

Conclusion: This study found that oral and intravenous administration of hydrocortisone and dexamethasone do not have a significantly differing impact on blood glucose levels. Capillary glucose monitoring is strongly recommended in all individuals who are on either oral or intravenous corticosteroids.

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口服与静脉注射氢化可的松和地塞米松对成年住院患者毛细血管血糖水平的不同影响--一项单中心研究。
背景:皮质类固醇会升高血糖浓度;然而,口服和静脉注射哪种给药方式与住院患者血糖升高程度最大相关,目前仍不得而知。此外,根据给药途径的不同,一天中相关的高血糖模式是否也有所不同:这是一项单中心回顾性研究,研究对象是接受口服或静脉注射氢化可的松和地塞米松治疗的 384 名成年住院患者。研究收集了七天内毛细血管葡萄糖浓度和用药时间的数据。应用重复测量混合模型比较了口服和静脉注射皮质类固醇的葡萄糖浓度随时间的变化。采用自回归协方差结构来模拟重复测量之间的相关性。该模型根据年龄、性别、入院前糖尿病和/或入院前皮质类固醇状态进行了调整:口服氢化可的松和静脉注射氢化可的松在第一天和所有七天中均无明显差异(平均差分别为 0.17mmol/l (-1.39, 1.75),p=0.827;平均差分别为 0.20mmol/l (-0.61, 1.01),p=0.639)。口服或静脉注射地塞米松的患者在第一天或所有七天的平均血糖浓度均无差异(分别为平均差 0.41mmol/l (-0.55,1.38), p=0.404 和平均差 -0.09mmol/l (-1.05,0.87), p=0.855):本研究发现,口服和静脉注射氢化可的松和地塞米松对血糖水平的影响没有明显差异。强烈建议所有口服或静脉注射皮质类固醇的患者进行毛细血管血糖监测。
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来源期刊
Clinical Medicine
Clinical Medicine 医学-医学:内科
CiteScore
7.20
自引率
0.00%
发文量
0
审稿时长
6-12 weeks
期刊介绍: Clinical Medicine is aimed at practising physicians in the UK and overseas and has relevance to all those managing or working within the healthcare sector. Available in print and online, the journal seeks to encourage high standards of medical care by promoting good clinical practice through original research, review and comment. The journal also includes a dedicated continuing medical education (CME) section in each issue. This presents the latest advances in a chosen specialty, with self-assessment questions at the end of each topic enabling CPD accreditation to be acquired. ISSN: 1470-2118 E-ISSN: 1473-4893 Frequency: 6 issues per year
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