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

From: A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy

Glycemic targets for most patients[38]:
A1C: ≤7.0 % FPG: 4.0–7.0 mmol/L 2-hr PPG: 5.0–10.0 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
  1. A1C glycated hemoglobin, FPG fasting plasma glucose, PPG postprandial plasma glucose, BG blood glucose; DPP-4 dipeptidyl peptidase-4, GLP-1 glucagon-like peptide-1.