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-indu...
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| creator | Blackmore, Lorna J Devine, Kirsty L Mackie, Sarah L |
| description | 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% |
| doi_str_mv | 10.1093/rheumatology/keac133.025 |
| format | Article |
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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%)
1 (12.5%)
4 (7.7%)
1(3.3%)
1(9.1%)
0 (0%)
Initial dose of prednisolone, mg
45.9
47.5
45.8
46.3
43.6
48.1
Screening
Diabetes n (%)
10 (16.7%)
3 (37.5%)
7 (13.5%)
9 (30%)
7 (63.6%)
2 (10.5%)
Pre-diabetes at baseline n (%)
1220%
450%
8 (15.4%)
7 (23.3%)
4 (36.4%)
3 (15.8%)
HbA1c checked n (%)
32 (53.3%)
7 (87.5%)
25 (48.1%)
28 (93.3%)
11 (100%)
17 (89.5%)
Counselled n (%)
7 (11.7%)
2 (25%)
5 (9.6%)
9 (30%)
3 (27.3%)
6 (31.6%)
Conclusion
The intervention improved monitoring for steroid-induced hyperglycaemia, improving detection rates. We identified patient counselling as a priority for future improvement work.
Disclosure
L.J. Blackmore: None. K.L. Devine: None. S.L. Mackie: Consultancies; On behalf of University of Leeds for AbbVie, AstraZeneca, Sanofi, Roche. Other; Support from Roche to attend EULAR2019.</description><identifier>ISSN: 1462-0324</identifier><identifier>EISSN: 1462-0332</identifier><identifier>DOI: 10.1093/rheumatology/keac133.025</identifier><language>eng</language><publisher>Oxford University Press</publisher><ispartof>Rheumatology (Oxford, England), 2022-04, Vol.61 (Supplement_1)</ispartof><rights>The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com. 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c1985-6a6afe207da6a6e918f0e01a933255fa46d8685848281b08ec0222e1306c681c3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids></links><search><creatorcontrib>Blackmore, Lorna J</creatorcontrib><creatorcontrib>Devine, Kirsty L</creatorcontrib><creatorcontrib>Mackie, Sarah L</creatorcontrib><title>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</title><title>Rheumatology (Oxford, England)</title><description>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%)
1 (12.5%)
4 (7.7%)
1(3.3%)
1(9.1%)
0 (0%)
Initial dose of prednisolone, mg
45.9
47.5
45.8
46.3
43.6
48.1
Screening
Diabetes n (%)
10 (16.7%)
3 (37.5%)
7 (13.5%)
9 (30%)
7 (63.6%)
2 (10.5%)
Pre-diabetes at baseline n (%)
1220%
450%
8 (15.4%)
7 (23.3%)
4 (36.4%)
3 (15.8%)
HbA1c checked n (%)
32 (53.3%)
7 (87.5%)
25 (48.1%)
28 (93.3%)
11 (100%)
17 (89.5%)
Counselled n (%)
7 (11.7%)
2 (25%)
5 (9.6%)
9 (30%)
3 (27.3%)
6 (31.6%)
Conclusion
The intervention improved monitoring for steroid-induced hyperglycaemia, improving detection rates. We identified patient counselling as a priority for future improvement work.
Disclosure
L.J. Blackmore: None. K.L. Devine: None. S.L. Mackie: Consultancies; On behalf of University of Leeds for AbbVie, AstraZeneca, Sanofi, Roche. Other; Support from Roche to attend EULAR2019.</description><issn>1462-0324</issn><issn>1462-0332</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><recordid>eNqNkEtOwzAQhiMEEqVwhzkAaf1IjMMOKl5SJRCFdeQ6k8SQxpWdLLJD4kqciJPg0gp1yWqe_z-aL4qAkgklGZ-6GvuV6mxjq2H6jkpTzieEpQfRiCaCxYRzdviXs-Q4OvH-jRCSUi5H0dcTYeL743PRV8qB6319Cd60VYOxxrZzCKovTAe2BK8dYhtmoNoCtO1bj02zqUvrwHforCli0xa9xgLqYY2uagatcGXUOSyVD13bQlcjXDvTGV_DwmqD3fBr8Lz3CFRGtR3o4A_KBefNOlS9KTAcxNPoqFSNx7NdHEevtzcvs_t4_nj3MLuax5pmMo2FEqpERi6KkAjMqCwJEqqygCRNS5WIQgqZykQySZdEoiaMMaScCC0k1Xwcya2vdtZ7h2W-dmal3JBTkm_o5_v08x39PNAPUr6V2n79f9UPA5qU4g</recordid><startdate>20220423</startdate><enddate>20220423</enddate><creator>Blackmore, Lorna J</creator><creator>Devine, Kirsty L</creator><creator>Mackie, Sarah L</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20220423</creationdate><title>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</title><author>Blackmore, Lorna J ; Devine, Kirsty L ; Mackie, Sarah L</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1985-6a6afe207da6a6e918f0e01a933255fa46d8685848281b08ec0222e1306c681c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Blackmore, Lorna J</creatorcontrib><creatorcontrib>Devine, Kirsty L</creatorcontrib><creatorcontrib>Mackie, Sarah L</creatorcontrib><collection>CrossRef</collection><jtitle>Rheumatology (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Blackmore, Lorna J</au><au>Devine, Kirsty L</au><au>Mackie, Sarah L</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>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</atitle><jtitle>Rheumatology (Oxford, England)</jtitle><date>2022-04-23</date><risdate>2022</risdate><volume>61</volume><issue>Supplement_1</issue><issn>1462-0324</issn><eissn>1462-0332</eissn><abstract>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%)
1 (12.5%)
4 (7.7%)
1(3.3%)
1(9.1%)
0 (0%)
Initial dose of prednisolone, mg
45.9
47.5
45.8
46.3
43.6
48.1
Screening
Diabetes n (%)
10 (16.7%)
3 (37.5%)
7 (13.5%)
9 (30%)
7 (63.6%)
2 (10.5%)
Pre-diabetes at baseline n (%)
1220%
450%
8 (15.4%)
7 (23.3%)
4 (36.4%)
3 (15.8%)
HbA1c checked n (%)
32 (53.3%)
7 (87.5%)
25 (48.1%)
28 (93.3%)
11 (100%)
17 (89.5%)
Counselled n (%)
7 (11.7%)
2 (25%)
5 (9.6%)
9 (30%)
3 (27.3%)
6 (31.6%)
Conclusion
The intervention improved monitoring for steroid-induced hyperglycaemia, improving detection rates. We identified patient counselling as a priority for future improvement work.
Disclosure
L.J. Blackmore: None. K.L. Devine: None. S.L. Mackie: Consultancies; On behalf of University of Leeds for AbbVie, AstraZeneca, Sanofi, Roche. Other; Support from Roche to attend EULAR2019.</abstract><pub>Oxford University Press</pub><doi>10.1093/rheumatology/keac133.025</doi><oa>free_for_read</oa></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current); Alma/SFX Local Collection |
| title | 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 |
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