Overview and Management of Glucocorticoid-Induced Hyperglycemia in Pulmonary Diseases: Insight into the COVID-19 Pandemic
Danielle Brooks MD, Carol J. Levy MD, CDCES
Background: Glucocorticoids are potent anti-inflammatory agents that have become an integral component of the standard of care for numerous pathologies. Their wide-ranging uses and efficacy in different treatment pathways are not without important adverse events to consider. Glucocorticoid-induced hyperglycemia remains a prominent issue but the optimal management is understudied. Pulmonary diseases represent a large disease group in which glucocorticoids have shown clinical benefits. Glucocorticoid-induced hyperglycemia in pulmonary disease has been associated with adverse patient outcomes. The coronavirus disease 2019 (COVID-19) pandemic has now introduced a novel indication for glucocorticoids and has further highlighted that hyperglycemia results in increased mortality. Methods: Here we review literature-based epidemiology, clinical outcomes, and treatment of glucocorticoid-induced hyperglycemia in chronic obstructive pulmonary disease, asthma, and most recently, COVID-19. Lastly, we provide a comprehensive review of the outcomes related to hyperglycemia, implications of glucocorticoid treatment, and treatment approaches to hyperglycemia in the COVID-19 pandemic. Conclusion: Management of people with diabetes requiring glucocorticoid therapy can be complex and require aggressive treatment. Awareness of the prevalence of hyperglycemia, attention to insulin and glucocorticoid action profiles, and treatment options can assist in improving glycemic outcomes.
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