Treatment of Glucocorticoid- induced hyperglycemia in hospitalized patients - A Systematic Review and Meta- Analysis

Abstract Purpose:Glucocorticoid (GC)-induced hyperglycemia is a frequent issue, however there are no specific guidelines for this diabetes subtype. Although treat-to-target insulin is recommended in general to correct hyperglycemia, it remains unclear which treatment strategy has a positive effect on outcomes. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess whether treating GC-induced hyperglycemia improves clinical outcomes. Methods: MEDLINE and EMBASE were systematically searched for RCTs on adults reporting treatment and outcomes of GC-induced hyperglycemia since the beginning of the data bases until August 2020. Glucose-lowering strategies as compared to usual care were investigated. Results: We found 14 RCTs with 595 patients and included seven trials in the quantitative analysis. Patients with an intensive glucose-lowering strategy had lower standardized mean glucose levels of – 0.42 mmol/l (95%CI -0.65 to -0.19) compared to usual care group patients. There was no increase in hypoglycemic events in the intensively treated groups (RR 0.87, 95%CI 0.48-1.56). Overall, we did not have enough trials reporting clinical outcomes for a quantitative analysis with only one trial reporting mortality. Conclusion: In GC-induced hyperglycemia, tight glucose control has a moderate effect on mean glucose levels with no apparent harmful effect regarding hypoglycemia, but there is insufficient data whether an intensive glucose-lowering strategy improves clinical outcomes. Systematic review registration Registered as CRD42020147409 at PROSPERO (https://www.crd.york.ac.uk/prospero/) on April 28, 2020