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Management of hyperglycaemia and steroid (glucocorticoid) therapy (October 2014)

This document aims to guide the management of hyperglycaemia in people given steroids as a hospital inpatient and following discharge. The prevalence of steroid use in hospital inpatients may be in excess of 10 per cent, in the context of an up-to 30 per cent prevalence of diabetes in hospital inpatients, which a mean diabetes prevalence of 16 per cent.

The use of steroid treatment in people with pre-existing diabetes will undoubtedly result in worsening glucose control, this may be termed steroid induced hyperglycaemia. This will warrant temporary, additional and more active glycaemic management. A rise in glucose, related to steroid therapy occurring in people without a known diagnosis of diabetes is termed steroid induced diabetes. This may or may be not resolved when the steroids are withdrawn.

This guideline, produced by the Joint British Diabetes Societies for Inpatient Care (JBDS-IP), constructs a framework for the recognition and management of steroid induced hyperglycaemia and steroid induced diabetes, and is designed for use by general physicians. Necessarily the guideline includes recommendations for the management of patients when they leave hospital and thus, this guidance may also be utilised for those treated with steroids in the outpatient department or in General Practice.

JBDS-IP is supported by Diabetes UK, the Association of British Clinical Diabetologists (ABCD) and the Diabetes Inpatient Specialist Nurse UK Group. The aim of JBDS-IP is to improve inpatient diabetes care throughout the UK. This is mainly through the development and use of high quality evidence based guidelines, and through better inpatient care pathways.

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