Table 12 Glycemic targets and treatment recommendations for GC-induced diabetes in adults

A1C: ≤7.0 %

FPG: 4.0–7.0 mmol/L

Management:

  Lifestyle interventions:

   • Initiate nutrition therapy and physical activity; if BG targets not met, initiate pharmacotherapy

  Pharmacotherapy:

If BG < 15 mmol/L:

Non-insulin therapies →

• Metformin

• Insulin secretagogues

→ If using once-daily prednisone, use shorter-acting agents (e.g., glyburide, gliclazide, repaglinide) dosed once-daily with prednisone

→ If using dexamethasone or shorter-acting agents > once/day, use longer-acting agents (e.g., gliclazide MR, glimepiride)

• DPP-4 inhibitor

• GLP-1 agonist

If BG < 15 mmol/L vs. >15 mmol/L

Insulin

→ Starting dose: 0.15-0.3 units/kg/day

→ If using once-daily prednisone in the morning, FPG less affected but BG will be higher later in the day:

 • Initiate intermediate-acting insulin (N or NPH) or a premixed combination of intermediate- and fast-acting insulin, administered in the morning

 • Add evening insulin if FPG is elevated

→ If using dexamethasone or shorter-acting agents > once/day, BG likely to be affected throughout the entire day:

 • Use intermediate-acting insulin twice daily or long-acting insulin (detemir, glargine)

 • Fast-acting insulin at mealtimes can be used in combination with intermediate- and long-acting insulin

Metformin

→ Often recommended in combination with insulin

Caution: If reducing the GC dose, adjust diabetes medications to avoid hypoglycemia