Management of patients taking long-term low-dose glucocorticoids

When screening for hyperglycaemia in patients without pre-existing diabetes who are taking a prolonged course of low-dose glucocorticoid (eg 5 to 10 mg prednisolone daily), consider performing an oral glucose tolerance test or glycated haemoglobin (HbA1c) test (see Tests to diagnose diabetes) because a fasting blood glucose concentration may not be elevated. However, an HbA1c will only reflect hyperglycaemia if blood glucose concentrations have been elevated for at least 2 to 3 months. If the patient meets the diagnostic thresholds for diabetes, treat as for patients with type 2 diabetes, including management of cardiovascular disease risk (see Approach to antihyperglycaemic treatment for adults with type 2 diabetes and Cardiovascular disease risk modification).

Patients with diabetes who are taking a prolonged course of low-dose glucocorticoids (eg 5 to 10 mg prednisolone daily) should measure postprandial blood glucose concentrations because results are likely to be higher than fasting blood glucose concentrations. Monitoring only fasting blood glucose concentrations may miss significant hyperglycaemia occurring later in the day.