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

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 preintervention 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.