Canterbury DHB

Haematology Patients

Key points

• SIH is a common problem.
• It may affect patients with (or without) a prior diagnosis of diabetes.
• Decisions about treatment need to be individualised as treatment goals differ significantly for each patient.
• Determining when and who to start or adjust treatment for can be challenging.

Recommendations

HbA1c should be measured in all patients as part of standard care:

• HbA1c should be measured < 3 months before starting treatment (if possible) or at presentation.
• Measurement makes it possible to optimise treatment for patients with pre-existing diabetes. It also helps determine whether management goals are being met.
• Type 2 diabetes and pre-diabetes are extremely common conditions. Many people will be asymptomatic. Screening provides an opportunity to identify these patients.
• Establishing the diagnoses of type 2 diabetes or pre-diabetes makes it possible to start appropriate treatment and manage lifestyle and behaviour.
• People with a completely normal HbA1c are at very low risk of developing steroid-induced hyperglycaemia unless they also have significant additional risk factors.

Risk factors for SIH

The following factors should be considered:

• Duration and potency of corticosteroid regimen.
• Pre-existing diagnosis of diabetes, particularly if the patient is already treated with insulin.
• Diagnosis of pre-diabetes (abnormal glucose tolerance).
• Older age of patient.
• Elevated BMI.

Monitoring capillary (finger prick) glucose in high risk patients

This is recommended:

• Pre-prandial and before-bed glucose levels should be monitored for 24 hours in hospitalised patients who are starting on steroids.
• A treatment decision can then be made in conjunction with the patient.

Treatment decisions

These depend on a number of factors:

• Glucose management goals will vary significantly between patients.
• Hyperglycaemia usually resolves once steroids are stopped.
• The principle aims of managing SIH are to prevent short-term complications and identify where treatment review is needed.
• Most long-term complications of diabetes occur after 5+ years. Consequently tight glycaemic targets may not be appropriate in many haematology patients, particularly if treatment is palliative.

The patient’s general practitioner should be involved in care decisions:

• Diabetes is a chronic, complex condition.
• Usually the GP is in the best position to monitor treatment and determine long-term goals with the patient.

Topic Code: 284653