1386-P: Confirmation of the Criteria for Insulin Administration at the Start of Steroid Therapy

Blood glucose elevates at initial high-dose steroid (HDS) administration and is prolonged by persistent amplification of glucagon-induced glycogenesis. Insulin (INS) administration at initial dose of HDS will avoid this. However, INS administration criteria regarding BS elevation are not defined. HDS were given based on COVID-treatment guidelines. HDS administration circumstances in clinical settings may clarify these criteria. The necessity of INS therapy at initial HDS administration is studied. COVID-inpatients receiving HDS, regarding a COVID-period in Japan comprising 5 waves, were sub-grouped into those requiring INS therapy and those not, and analyzed with respect to age, BMI, fasting blood glucose (FBS) , A1c, C-peptide (CPR) index, CPR/glucagon (GCG) . INS was administered, target BS level 200 mg/dL or less at 14:00, depending on BS level after HDS administration. From 396 patients, 257 received HDS as follows, 1of the 154 patients in Wave 1-3 (69.5 ± 16.7 years, BMI 23.9 ± 4.8%, A1c 6.3 ± 1.1%) , 79 of the 83 patients in Wave 4 (64.5 ± 14.6 years, BMI 24.9 ± 4.78, A1c 6.6 ± 1.1%) , and 73 of the 117 patients in Wave 5 (54.4 ± 15.2 years, BMI 25.2 ± 5.1, A1c 6.2 ± 0.8%) . Of the 257 patients above, 145 were treated with INS. In all Waves, only FBS and A1c differed significantly between INS-treated and non-INS-treated patients. ROC analysis in Wave 1-3, Wave 4 and Wave 5 showed cut-off values of A1c (sensitivity/specificity) and FBS (sensitivity/specificity) measuring 6.1% (0.85/0.62) and 121.5 mg/dL (1.00/ 0.62) , 6.5% (0.44/0.83) and133.5 mg/dL (0.40/0.93) , and 6.4% (0.49/1.0) and 112.5 mg/dL (0.81/0.85) , respectively. In patients with FBS levels of 112.5 mg/dL or higher or A1c levels of 6.3% or higher, the use of INS from the initial HDS administration reduced prolongation of hyperglycemia. Variables BMI, CPR, and GCG secretion cannot determine the need for INS therapy. It is important to use FBS and A1c levels, according to conventional practice, to ascertain if INS administration is necessary.