PPF19 A spoonful of sugar monitoring: detecting steroid-induced hyperglycaemia in palliative care

<h3>Background</h3> Steroid-induced hyperglycaemia is a common yet frequently under-recognised complication in palliative care, with the potential to negatively affect patient comfort and quality of life.^{1 2} Existing national guidance, including recommendations from the Joint British Diabetes Societies and Diabetes UK, primarily address either non-palliative patients receiving corticosteroids or with hyperglycaemia at the end of life.^{3 4} Consequently, a gap in guidance exists for the broader palliative population who are receiving corticosteroids but not imminently dying. <h3>Aim</h3> To improve the detection of steroid-induced hyperglycaemia within a hospice setting through targeted staff education and implementation of structured glucose monitoring. <h3>Methods</h3> A baseline audit of current practice demonstrated inconsistent monitoring of blood glucose levels among patients prescribed corticosteroids. In response, an education programme was delivered to all clinical staff, highlighting recognition, monitoring, and management of steroid-induced hyperglycaemia in the specialist palliative care inpatient unit. A structured monitoring protocol was introduced, specifying frequency and timing of glucose checks for patients on corticosteroids. <h3>Results</h3> Following implementation, all patients prescribed corticosteroids (100%) underwent regular glucose monitoring in accordance with the protocol. This allowed for earlier identification of hyperglycaemia, enabling prompt clinical review and timely adjustments to management plans. Feedback from nursing and medical staff highlighted increased confidence in recognising and responding appropriately to abnormal results. <h3>Conclusions</h3> The implementation of a structured glucose monitoring protocol, supported by focused staff education, has led to consistent glucose monitoring for all patients on corticosteroids, improving early detection and management of steroid-induced hyperglycaemia in the hospice setting. These findings will inform the development of a new local guideline to promote staff confidence in delivering evidence-based consistent management of corticosteroid-related hyperglycaemia in palliative care. <h3>References</h3> Pilkey J, Streeter L, Beel A, Hiebert T, Li X. Corticosteroid-induced diabetes in palliative care. <i>Journal of Palliative Medicine</i> 2012;<b>15</b>(6):681–689. doi:https://doi.org/10.1089/jpm.2011.0513 . Golubic R, Caleyachetty R, Barber TM, Adler A. Glucocorticoid-induced hyperglycaemia and diabetes: call for action. <i>Diabetic Medicine</i> [online] 2022;<b>39</b>(8). doi: https://doi.org/10.1111/dme.14843 . Joint British Diabetes Societies (JBDS) for Inpatient Care [PDF]; Management of Hyperglycaemia and Steroid (Glucocorticoid) Therapy. (2023). Available at: https://abcd.care/sites/default/files/site_uploads/JBDS_Guidelines_Current/JBDS_08_Management_of_Hyperglycaemia_and_Steroid_%28Glucocorticoid%29_Therapy_with_QR_code_January_2023.pdf Trend Diabetes, END OF LIFE GUIDANCE FOR DIABETES CARE. (2024). Available at: https://www.diabetes.org.uk/sites/default/files/2025-03/EoL_TREND_2024_v11-1.pdf