P026 Sugar rush: single-centre audit of screening and counselling for steroid-induced hyperglycaemia, based on the British Society for Rheumatology giant cell arteritis guideline

Abstract Background/Aims In patients starting steroids for giant cell arteritis (GCA), to evaluate adherence to BSR guideline: HbA1c monitoring, documentation of counselling, and detection of steroid-induced hyperglycaemia. Methods Data were gathered from the electronic medical records. Steroid-induced hyperglycaemia was defined as new HbA1c >48 measured 3+ months after beginning steroid treatment. The data were presented at a regional meeting to raise awareness and encourage clinicians to incorporate counselling and monitoring into their practice, and a GCA clinic was set up. Practice was then re-evaluated. Results In the baseline dataset, 60 patients with GCA had a mean age of 72; 47 were female; mean body mass index (BMI) was 27 (for the 39/60 with a recorded height and weight). Mean initial dose of prednisolone was 45.9mg. The re-audit cohort were comparable with a mean age of 73.1; 19 females and mean BMI of 27 (for 15/30 with recorded). Mean initial prednisolone dose of 46.3mg. Baseline HbA1c was checked in 32/60 (53%) initially, and 28/30 (93%) on re-audit. 7/60 (12%) had documentation of counselling for steroid-induced hyperglycaemia initially, which increased to 9/30 (30%) on re-audit. Hyperglycaemia was detected in 8/60 (13%) of the initial audit group, compared to 11/30 (36%) in the re-audit. In the initial cohort, 3/10 (30%) of those with diabetes at baseline developed hyperglycaemia and 4/12 (33%) of those with pre-diabetes at baseline developed hyperglycaemia. In the re-audit, 7/9 (78%) of those with diabetes at baseline developed hyperglycaemia and 4/7 (57%) with pre-diabetes at baseline developed hyperglycaemia. Those who developed hyperglycaemia had a higher baseline weight and BMI (Table 1) in both the initial cohort and re-audit. P026 Table 1 Initial cohort Re-audit Averages and percentages Total pop. Hyperglycaemia No Hyperglycaemia Total population Hyper-glycaemia No hyper- glycaemia Total 60 8 52 30 11 19 Risk factors Age 72.3 70.6 72.6 73.1 76.5 71.1 Gender Female, n (%) 47 (78%) 06 (75%) 41 (79%) 19 (63%) 7 (64%) 12 (63%) Weight 72.1 (median = 71.7) 89.5 (median = 82.4) 70.8 (median = 70.1) 72.7 (median = 71.1) 77.5 (median = 75) 69.6 (median = 68.2) BMI 27.0 29.8 26.6 27.5 31.3 25.6 HTN n (%) 27 (45%) 2 (25%) 25 (48.1%) 16 (53%) 6(54.5%) 10 (52.6%) Smoker n (%) 15 (25%) 2 (25%) 13 (25%) 11 (36.7%) 3 (27.3%) 8 (42.1%) Raised HbA1c n (%) 22 (36.7%) 6 (75%) 15 (28.8%) 13 (43.3%) 7 (63.6%) 6 (31.6%) Fasting glucose raised n (%) 4 (1.7%