Available online 5 August 2022

Various antihyperglycemic regimens have been studied for glucocorticoid-induced hyperglycemia

No standardized treatment guidelines exist for glucocorticoid-induced hyperglycemia

Effective insulin protocols for dexamethasone-associated COVID-19 hyperglycemia are needed

Optimal glucocorticoid-induced hyperglycemia management is unclear. The COVID-19 pandemic has made this issue more prominent since dexamethasone became the standard of care in patients needing respiratory support. The objective of this systematic review is to describe the management of glucocorticoid-induced hyperglycemia and to summarize available management strategies for dexamethasone-associated hyperglycemia in COVID-19 patients.

A systematic review was conducted using PubMed/Medline, the Cochrane Library, Embase, and Web of Science databases with results from 2011 through January 2022. Keywords included synonyms for “steroid-induced diabetes” or “steroid-induced hyperglycemia.” Randomized controlled trials were included for review of glucocorticoid-induced hyperglycemia management. All studies focusing on dexamethasone-associated hyperglycemia in COVID-19 were included regardless of study quality.

Initial search for non-COVID glucocorticoid-induced hyperglycemia identified 1230 references. After screening and review, 33 articles were included in the non-COVID section of this systematic review. Initial search for COVID-19-related management of dexamethasone-associated hyperglycemia in COVID-19 identified 63 references while 7 of these were included in the COVID-19 section. Randomized controlled trials of management strategies were scarce, did not use standard definitions for hyperglycemia, evaluated a variety of treatment strategies with varying primary endpoints, and were generally not found to be effective except for NPH insulin added to basal-bolus regimens.

Few randomized controlled trials are available evaluating glucocorticoid-induced hyperglycemia management. Further studies are needed to support the formulation of clinical guidelines for glucocorticoid-induced hyperglycemia especially given the widespread use of dexamethasone during the COVID-19 pandemic.

Glucocorticoid

Dexamethasone

Steroid

Diabetes

Hyperglycemia

COVID-19

© 2022 Published by Elsevier Inc. on behalf of the AACE.