Insulin therapy with a standardized decision support system for acute graft-versus-host disease patients with steroid-induced hyperglycemia

Steroids have been extensively used in graft-versus-host disease (GvHD). Hyperglycemia is the most common side effect of glucocorticoids. It has been shown that steroid-induced hyperglycemia (SIHG) is associated with high mortality rates in patients with acute GvHD (aGvHD). However, it has not yet been evaluated whether SIHG is an underlying parameter for poor prognosis in aGvHD. Therefore, Felix Aberer from Medical University of Graz, Graz, Austria, and colleagues conducted a single center, randomized controlled study to assess the feasibility and safety using an automated of a standardized decision support system (GlucoTab, a software, that provides bolus and basal insulin dosing algorithm based on the patient’s glucose level) for suitable insulin therapy in aGvHD patients with SIHG. The results of the study were published ahead of print in the Journal of Diabetes Investigation in August 2018.

Ten hyperglycemic patients with aGvHD, who previously received steroid therapy, were enrolled in this feasibility study. All patients were randomized and received either GlucoTab or standard of care (SOC). Study endpoints included feasibility (assessed by the median glucose and percentage of plasma glucose values during steroid therapy) and safety (assessed by the percentage of hypoglycemic events) of SIHG therapy.

Patient characteristics:

• N = 10 patients with aGvHD
• Median age in the GlucoTab and SOC groups = 55±13 vs 60±4 years

Key findings:

• Follow-up: 6 months
• Glucose readings in the GlucoTab and SOC groups: 364 vs 1020
• Median overall plasma glucose levels in the GlucoTab group and the SOC group: 151 (range, 123–192) vs 162 (range, 138–193) mg/dl, P < 0.001, respectively
• Median fasting plasma glucose levels in the GlucoTab group and the SOC group: 131 (range, 113–164) vs 152 (range, 134–18) mg/dl, P < 0.001, respectively
• Bedtime plasma glucose levels in the GlucoTab and the SOC group: 159 (range, 133–202) vs 188 (range, 160–211) mg/dl, P < 0.001, respectively
• Median daily insulin dose levels in the GlucoTab and the SOC groups: 38±29 IU vs 11±12 IU, P < 0.001
• Mean prednisolone dose was significantly higher in the SOC group, P < 0.001

This is the first study investigating GlucoTab for SIHG therapy in patients with aGvHD. This data reflects that treatment of SIHG with GlucoTab, an algorithm based system for subcutaneous insulin dosing, is clinically feasible and safe. The authors added that these findings require further investigation in larger clinical trials.