ESPE Abstracts

Glucocorticoids are widely used to treat autoimmune and inflammatory diseases. The side-effects of glucocorticoids are well known, but not routinely monitored in the pediatric population. Recommendations regarding the timing of blood glucose screening are lacking and understanding about the correlation between different glucocorticoid treatment regimens and glucose variability is insufficient. Our objective was to test the usability of continuous glucose monitooring (CGM) to detect glucocorticoid-induced hyperglycaemia (GIH) and to alalyze the glucose profile in children receiving systemic glucocorticoid treatment. Three pediatric patients with different underlying diseases receiving systemic glucocorticoid treatment in a dose of at least 1 mg/kg/day prednisolone-equivalent were started on CGM in a hospital or non-hospital setting. Patients receiving systemic glucocorticoids during the last 30 days were excluded from the study. Patients stuck to their regular meal times and kept a food diary. Medronic iPro2 CGM with an Enlite sensor was used in all the subjects. Data from CGM was uploaded and analyzed retrospectively at the end of the treatment course or CGM life-time. Time above range (TAR – the percentage of time, when sensor glucose is above 10 mmol/L) and average sensor glucose (ASG) was measured and diurnal glucose fluctuations were analyzed in each study subject. The first study subject was a 14-year-old girl with newly diagnosed autoimmune hepatitis started on prednisolone 1mg/kg per mouth daily for seven days. Her TAR was 32% and ASG 9.1 mmol/l for the whole study period. Her glucose readings were above 10 mmol/l most frequently during the hours 16:00-24:00. The second study subject was a 10-year-old girl with treatment-resistant epilepsy, who received intravenous Solu-Medrol in a prednisolone-equivalent dose of 35.5 mg/kg/die on all four study days. Her TAR was 9% and ASG level 7.0 mmol/L. The typical time period for GIH episodes to occur was from 18:00-22:00 in the evening. The third study subject was a 4-year-old girl with focal epilepsy, who received intravenous Solu-Medrol in a prednisolone-equivalent dose of 39 mg/kg/die. Her TAR was 8% and ASG 6.8 mmol/L. The highest glucose values were measured during 16:00-20:00 in the evening. All the study subjects had GIH episodes regardless of their age or glucocorticoid dose. GIH episodes occurred most frequently in the evening regardless of glucocorticoid administration time and this should be taken into account, when screening for glucocorticoid-induced-hyperglycemia. Further subjects are expected to be studied and presented for the meeting.