Vrednotenje ustreznosti in optimizacija antidiabetične terapije pri bolnikih, ki med bolnišničnim zdravljenjem na Kliniki Golnik prejemajo sistemske glukokortikoide

Gruban, Jasna (author), Kerec Kos, Mojca (mentor), Dobravc Verbič, Matej (co-mentor)

Sistemski glukokortikoidi se pogosto uporabljajo za zdravljenje pljučnih in drugih bolezni. Eden izmed pogostejših neželenih učinkov glukokortikoidov je porast krvnega sladkorja, ki zahteva ustrezno obravnavo. Namen raziskave je bil analiza in ocena uravnavanja vrednosti krvnega sladkorja pri bolnikih, ki so v času bolnišničnega zdravljenja na Kliniki Golnik prejemali sistemske glukokortikoide. V času raziskave smo pripravili Protokol zdravljenja z glukokortikoidi povzročene hiperglikemije. V štirimesečno retrospektivno raziskavo (maj-avgust 2019) smo vključili vse bolnike, ki so med hospitalizacijo vsaj 2 dni prejemali sistemske glukokortikoide in imeli izmerjeni vsaj 2 vrednosti krvnega sladkorja ⡥ 7,0 mmol/l zjutraj na tešče ali ⡥ 10,0 mmol/l kadarkoli čez dan. Od skupno 280 bolnikov, ki so v času raziskave med hospitalizacijo prejemali sistemske glukokortikoide, smo v raziskavo vključili 55 bolnikov (20 %) z ugotovljeno hiperglikemijo. Pri 30 bolnikih je tekom zdravljenja prišlo do poslabšanja obstoječe sladkorne bolezni, pri 3 bolnikih do novo odkrite sladkorne bolezni in pri 22 bolnikih do prehodnega steroidnega diabetesa. Skupno je bilo opravljenih 1535 meritev krvnega sladkorja, od katerih je bilo 57,3 % vrednosti povišanih. Povprečna vrednost meritev zjutraj na tešče je bila 7,94 ± 3,31 mmol/l, čez dan pa 11,28 ± 4,20 mmol/l. 45 bolnikov (82 %) je imelo tekom hospitalizacije povišanih več kot 5 meritev ali > 20 % meritev krvnega sladkorja. Skupno je imelo 9 bolnikov (16,4 %) urejene vrednosti krvnega sladkorja po vseh treh postavljenih kriterijih. Do prilagoditve antidiabetične terapije (uvedba, zamenjava, ukinitev, sprememba odmerjanja antidiabetikov) je prišlo pri 35 bolnikih (63,6 %). Glede na protokol zdravljenja bi do prilagoditve antidiabetične terapije moralo priti pri dodatnih 18 bolnikih (32,7 %). 18 bolnikov je imelo hiperglikemijo popolnoma zdravljeno v skladu s pripravljenim protokolom. Pri več kot 80 % bolnikov nadzor z glukokortikoidi povzročene hiperglikemije v času bolnišničnega zdravljenja ni bil ustrezen. Izdelani protokol zdravljenja lahko pripomore k ustreznejši obravnavi tovrstnih bolnikov v prihodnje.

• Language: Slovenian
• Keywords: glukokortikoidi, sladkorna bolezen, hiperglikemija povzročena z glukokortikoidi, steroidni diabetes, protokol zdravljenja
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2020
• PID: 20.500.12556/RUL-121433
• Publication date in RUL: 09.10.2020

Secondary language

• Language: English
• Title: Evaluation and optimization of antidiabetic treatment in patients receiving systemic glucocorticoid therapy during hospitalisation at the University Clinic Golnik

Abstract

Systemic glucocorticoids are commonly used for the treatment of lung diseases and other illnesses. One of the more common side effect of glucocorticoids that requires proper treatment is elevated blood sugar. The purpose of this study was to analyze and evaluate the regulation of blood sugar levels in patients who received systemic treatment with glucocorticoids during their hospital treatment at the University Clinic Golnik. During the study, we developed a treatment protocol for glucocorticoid-induced hyperglycemia. The four-month retrospective study (May-August 2019) included all patients who received systemic glucocorticoids for at least 2 days during hospitalisation and had at least 2 measured blood sugar values of ⡥ 7.0 mmol/L in the morning on an empty stomach or ⡥ 10.0 mmol/L anytime during the day. Out of 280 patients who were receiving systemic glucocorticoids during their hospitalisation, 55 patients (20 %) with established hyperglycemia were included in the study. 30 patients developed exacerbation of pre-existing diabetes during treatment, 3 patients developed newly diagnosed diabetes, and 22 patients developed steroid diabetes. A total of 1,535 blood sugar measurements were performed, of which 57.3 % presented elevated values. The mean value of measurements in the morning on an empty stomach was 7.94 ± 3.31 mmol/L, whereas measurements during the day showed a mean value of 11.28 ± 4.20 mmol/L. During their hospitalisation, 45 patients (82 %) presented more than 5 elevated measurements of blood sugar or > 20 % of a patient’s total measurements. A total of 9 patients (16,4 %) had regulated blood sugar levels according to all three criteria. Some form of antidiabetic therapy adjustment (initiation, replacement, discontinuation, change of dosage of antidiabetics,) was undertaken with 35 patients (63.6 %). Only 18 patients had their hyperglycemia treated in full accordance with the treatment protocol. Treatment of glucocorticoid-induced hyperglycemia was inadequate in more than 80 % of patients. The developed treatment protocol can help to better treat such patients.

• Keywords: glucocorticoids, diabetes, glucocorticoid-induced hyperglycemia, steroid diabetes, treatment protocol