Obstructive Lung Diseases |

Corticosteroids Cause Hyperglycemia in Patients With Acute Chronic Obstructive Pulmonary Disease Exacerbation FREE TO VIEW

Ebtesam Islam, PhD; Chok Limsuwat, MD; Gilbert Berdine, MD; Raed Alalawi, MD; Keneth Nugent, MD
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Texas Tech University Health Sciences Center, Lubbock, TX

Chest. 2013;144(4_MeetingAbstracts):703A. doi:10.1378/chest.1704906
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SESSION TITLE: COPD Diagnosis & Evaluation Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Patients with chronic obstructive pulmonary disease (COPD) exacerbations are typically treated with corticosteroids. These can cause hyperglycemic events that were associated with poor outcomes in studies of acute myocardial infarction, stroke, and pneumonia. Our aim in this study was to determine the extent of hyperglycemia caused by corticosteroids used to treat COPD exacerbations.

METHODS: We retrospectively reviewed patients admitted from July 1, 2008 through June 30, 2009. We included all adult patients with a discharge diagnosis of COPD exacerbation; we excluded patients younger than 18 years of age and those admitted to the ICU. Data compiled included FEV1, history of diabetes, blood glucose at admission, maximum (max) glucose, and maximum dose of corticosteroid.

RESULTS: Thirty-five patients were included - 22 non-diabetic patients (Non-DM) and 13 with diabetes (DM). Non-DM had a mean initial glucose of 121 (83-238). 31.8% (n=7) had a max glucose above 200. The mean change in glucose (max in hospital - initial) was 63g/dl. DM patients had a mean initial glucose of 180 (77-446), 77% (n=10) had a max glucose above 200, and the mean change in glucose was 127g/dl. The initial, max, and change in glucose levels in DM group were higher than in the non-DM group (p<0.05, all comparisons). We stratified the patients into four quartiles based on the maximum dose of corticosteroids received during treatment (Group 1 received lowest 25% of corticosteroid doses; Groups 4 received highest 25%). The mean initial blood glucose levels in Groups 1-4 were: 179, 140, 132, and 116, respectively (p>0.05). The mean max glucose levels in Groups 1-4 were: 251, 268, 200, and 192, respectively (p>0.05).

CONCLUSIONS: Our data demonstrate that both DM and non-DM COPD patients treated with steroids developed significant hyperglycemia. The increase in blood glucose levels with corticosteroids did not correlate with the maximum dose.

CLINICAL IMPLICATIONS: Corticosteroid use leads hyperglycemia in most patients treated for COPD. This may have a significant effect on morbidity in these patients.

DISCLOSURE: The following authors have nothing to disclose: Ebtesam Islam, Chok Limsuwat, Gilbert Berdine, Raed Alalawi, Keneth Nugent

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