{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T01:54:01Z","timestamp":1784685241315,"version":"3.55.0"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T00:00:00Z","timestamp":1631750400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Glucocorticoid (GC)-exacerbated hyperglycemia is prevalent in hospitalized patients with diabetes mellitus (DM) but evidence-based insulin guidelines in inpatient settings are lacking.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>Retrospective cohort study with capillary blood glucose (CBG) readings and insulin use, dosed with 50% basal (glargine)-50% bolus (lispro) insulin, analyzed in hospitalized patients with insulin-treated DM given GC and matched controls without GC (n = 131 pairs). GC group (median daily prednisone-equivalent dose: 53.36 mg (IQR 30.00, 80.04)) had greatest CBG differences compared to controls at dinner (254\u00b169 vs. 184\u00b163 mg\/dL, P&lt;0.001) and bedtime (260\u00b172 vs. 182\u00b155 mg\/dL, P&lt;0.001). In GC group, dinner CBG was 30% higher than lunch (254\u00b169 vs. 199\u00b177 mg\/dL, P&lt;0.001) when similar lispro to controls given at lunch. Bedtime CBG not different from dinner when 20% more lispro given at dinner (0.12 units\/kg (IQR 0.08, 0.17) vs. 0.10 units\/kg (0.06, 0.14), P&lt;0.01). Despite receiving more lispro, bedtime hypoglycemic events were lower in GC group (0.0% vs. 5.9%, P = 0.03).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Since equal bolus doses inadequately treat large dinner and bedtime GC-exacerbated glycemic excursions, initiating higher bolus insulin at lunch and dinner with additional enhanced GC-specific insulin supplemental scale may be needed as initial insulin doses in setting of high-dose GC.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0256682","type":"journal-article","created":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T17:36:38Z","timestamp":1631813798000},"page":"e0256682","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Insulin management in hospitalized patients with diabetes mellitus on high-dose glucocorticoids: Management of steroid-exacerbated hyperglycemia"],"prefix":"10.1371","volume":"16","author":[{"given":"Yu-Chien","family":"Cheng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5294-9611","authenticated-orcid":true,"given":"Yannis","family":"Guerra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5531-4416","authenticated-orcid":true,"given":"Michael","family":"Morkos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"Tahsin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chioma","family":"Onyenwenyi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louis","family":"Fogg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon","family":"Fogelfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,9,16]]},"reference":[{"key":"pone.0256682.ref001","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1210\/jcem.87.3.8341","article-title":"Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes","volume":"87","author":"GE Umpierrez","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0256682.ref002","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1136\/thx.2005.051029","article-title":"Hyperglycaemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease","volume":"61","author":"EH Baker","year":"2006","journal-title":"Thorax"},{"key":"pone.0256682.ref003","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1111\/imj.12157","article-title":"Relationship between glycaemia and length of hospital stay during an acute exacerbation of chronic obstructive pulmonary disease","volume":"43","author":"MG Burt","year":"2013","journal-title":"Intern Med J"},{"key":"pone.0256682.ref004","doi-asserted-by":"crossref","first-page":"358","DOI":"10.4158\/EP.12.4.358","article-title":"Prevalence and predictors of corticosteroid-related hyperglycemia in hospitalized patients","volume":"12","author":"AC Donihi","year":"2006","journal-title":"Endocr Pract"},{"key":"pone.0256682.ref005","article-title":"Dexamethasone in hospitalized patients with Covid-19\u2014preliminary report","author":"RECOVERY Collaborative Group","year":"2020","journal-title":"NEJM"},{"key":"pone.0256682.ref006","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1210\/jc.2011-2098","article-title":"Management of hyperglycemia in hospitalized patients in non-critical care setting: an Endocrine Society clinical practice guideline","volume":"97","author":"GE Umpierrez","year":"2012","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0256682.ref007","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1111\/j.1365-2362.2008.02067.x","article-title":"Diamant M: Novel insights into glucocorticoid-mediated diabetogenic effects: towards expansion of therapeutic options?","volume":"39","author":"DH van Raalte","year":"2009","journal-title":"Eur J Clin Invest"},{"key":"pone.0256682.ref008","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.2337\/diab.30.12.1000","article-title":"The effect of insulin on the disposal of intravenous glucose. 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