An Evaluation of Insulin Use in Hospitalized Patients with Corticosteroid-Related Hyperglycemia

Abstract Purpose This study evaluated insulin use in hospitalized patients who developed corticosteroid-related hyperglycemia to assess current insulin management strategies, glycemic outcomes, and opportunities for optimizing institutional practice. Methods This retrospective study was conducted at a community-based teaching health system and included hospitalized adults who experienced clinically significant hyperglycemia (blood glucose >250 mg/dL) on at least two occasions during admission between September 2024 and September 2025. The primary outcome was the percentage of patients administered intermediate or long-acting insulin following hyperglycemia. The secondary endpoints evaluated glycemic control, hypoglycemia, timing of insulin orders, and administration of optimized insulin regimens based on pharmacokinetics. This project was deemed exempt by the IRB. Results Of 1,361 patient encounters screened, 708 unique patients were included, and 610 had type II diabetes (T2DM). Intermediate or long-acting insulin was administered more frequently in patients with T2DM than those without (71.1% vs 41.8%, p<0.001). A minority of patients had insulin before or with the first dose of steroid (T2DM 35.1% vs without T2DM 13.3%). Glycemic control was achieved most frequently in patients without T2DM (52% vs 35%, p<0.001). Conclusions This study showed that a higher percentage of patients with T2DM received insulin before or with the first dose of steroid when compared to patients without T2DM. However, in both groups, a majority of patients received insulin after the first dose of steroid. Findings suggest that hospitalized adults with or without diabetes who develop corticosteroid-related hyperglycemia will benefit from receiving an intermediate or long-acting insulin concurrently with the ordered steroid.