Chronic obstructive pulmonary disease exacerbations, ‘Sugar Sugar’, what are we monitoring?

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Abstract

Background:

High-dose prednisolone is the mainstay of treatment for chronic obstructive pulmonary disease (COPD) exacerbation and commonly causes hyperglycaemia that requires management. Routine blood glucose level (BGL) tests four times a day should be performed to monitor for hyperglycaemia in this group.

Objective:

To investigate the impact of pharmacist intervention to improve BGL monitoring and recording for COPD inpatients treated with high-dose prednisolone.

Design:

A pre- and post-intervention design was used. Pre-intervention data were collected retrospectively and post-intervention data prospectively. The main endpoints were the proportion of patients with BGLs monitored at least three times a day (which was considered to be the minimum clinical requirement) and evaluation of the time period BGL monitoring occurred. Secondary assessments were to explore hyperglycaemia management and the use of HbA1c as a tool for detecting unknown diabetics.

Results:

A greater proportion of post-intervention patients achieved the minimum required monitoring on Day 1 compared to the pre-intervention group (29 vs 7%, p = 0.043). An improvement in monitoring occurred on Day 2 (42 vs 17%, p = 0.048). The post-intervention group had a higher mean number of BGL tests during all time periods of the day with a threefold increase between 1400 and 2400 hours (2.4 ± 1.9 vs 0.8 ± 1.2, p = 0.00).

Conclusion:

Pharmacist intervention can significantly improve BGL monitoring, including targeting of the time period crucial for detecting steroid-induced hyperglycaemia.

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