Online Exclusive Article

Management of Steroid-Induced Hyperglycemia in Hospitalized Patients With Cancer: A Review

Veronica J. Brady

Deanna E. Grimes

Terri S. Armstrong

Geri LoBiondo-Wood

hospitalized patients, steroids, hyperglycemia
ONF 2014, 41(6), E355-E365. DOI: 10.1188/14.ONF.E355-E365

Problem Identification: Glucocorticoids are prescribed for hospitalized patients with cancer for a variety of reasons, including cerebral edema, treatment and prevention of nausea, and as part of cancer treatment regimens. Glucocorticoids are known to cause hyperglycemia. The purpose of this study was to integrate the published research on the management and the effects of steroid-induced hyperglycemia in hospitalized adult patients with cancer with or without preexisting diabetes.

Literature Search: MEDLINE®, PubMed, EMBASE, CINAHL®, and Scopus electronic databases were used to identify relevant articles. Bibliographies of included studies were reviewed for any pertinent studies that were not obtained through database search.

Data Evaluation: 1,392 studies were identified. A total of 18 studies that met criteria were fully reviewed, 6 of which met all of the inclusion criteria.

Data Analysis: Data were abstracted from the included studies using a systematic code sheet to document characteristics of the studies and findings on management of hyperglycemia. Characteristics of the studies and findings on management of hyperglycemia were organized into three tables: the patients did not have preexisting diabetes, the patients had preexisting diabetes, and patients with or without preexisting diabetes were both included in the study. Management and effects of management of hyperglycemia were then compared and synthesized.

Presentation of Findings: Hyperglycemia occurs in hospitalized patients with cancer irrespective of whether patients have a prior history of diabetes. Hyperglycemia resulting from steroids is treated in a variety of ways, but the resulting glycemic control has not been consistently documented. However, this review suggests that scheduled insulin (basal-bolus) is effective in attainment of glucose targets.

Implications for Practice: Nurses should be aware of the effect that steroids have on glycemic control in patients and should be empowered to request or perform blood glucose monitoring when appropriate. Nurses can identify those patients receiving steroids and assess for signs and symptoms of hyperglycemia. They also can review routine laboratory results and assess for hyperglycemia in patients receiving steroids.

Jump to a section


    American Diabetes Association. (2011). Standards of medical care in diabetes—2011. Diabetes Care, 34(Suppl. 1), S11-S61. doi:10.2337/dc11-S011
    American Diabetes Association. (2013). Standards of medical care in diabetes—2013. Diabetes Care, 36(Suppl. 1), S11-S66. doi:10.2337/dc13-S011
    Clore, J. N., & Thurby-Hay, L. (2009). Glucocorticoid-induced hyperglycemia. Endocrine Practice, 15, 469-474. doi:10.4158/EP08331.RAR
    Donihi, A. C., Raval, D., Saul, M., Korytkowski, M. T., & DeVita, M. A. (2006). Prevalence and predictors of corticosteroid-related hyperglycemia in hospitalized patients. Endocrine Practice, 12, 358-362.
    Gogas, H., Shapiro, F., Aghajanian, C., Fennelly, D., Almadrones, L., Hoskins, W. J., & Spriggs, D. R. (1996). The impact of diabetes mellitus on the toxicity of therapy for advanced ovarian cancer. Gynecologic Oncology, 61, 22-26. doi:10.1006/gyno.1996.0090
    Gonzalez-Gonzalez, J. G., Mireles-Zavala, L. G., Rodriguez-Gutierrez, R., Gomez-Almaguer, D., Lavalle-Gonzalez, F. J., Tamez-Perez, H. E., … Villarreal-Perez, J. Z. (2013). Hyperglycemia related to high-dose glucocorticoid use in noncritically ill patients. Diabetology and Metabolic Syndrome, 5, 18. doi:10.1186/1758-5996-5-18
    Gosmanov, A. R., Goorha, S., Stelts, S., Peng, L., & Umpierrez, G. E. (2013). Management of hyperglycemia in diabetic patients with hematologic malignancies during dexamethasone therapy. Endocrine Practice, 19, 231-235. doi:10.4158/EP12256.OR
    Gulliford, M. C., Charlton, J., & Latinovic, R. (2006). Risk of diabetes associated with prescribed glucocorticoids in a large population. Diabetes Care, 29, 2728-2729. doi:10.2337/dc06-1499
    Guo, Y., Chandran, S., Palmer, J. L., & Bruera, E. (2011). The influence of hyperglycemia and other clinical variables on rehabilitation and hospital length of stay after neurosurgery in patients with cancer. American Journal of Hospice and Palliative Care, 28, 90-93. doi:10.1177/1049909110374455
    Holtan, S. G., Pasquini, M., & Weisdorf, D. J. (2014). Acute GVHD: A bench to bedside update. Blood, 124, 363-373. doi:10.1182/blood-2014-01-514786
    Inzucchi, S. E. (2006). Clinical practice. Management of hyperglycemia in the hospital setting. New England Journal of Medicine, 355, 1903-1911. doi:10.1056/NEJMcp060094
    Iwamoto, T., Kagawa, Y., Naito, Y., Kuzuhara, S., & Kojima, M. (2004). Steroid-induced diabetes mellitus and related risk factors in patients with neurologic diseases. Pharmacotherapy, 24, 508-514.
    Krone, C. A., & Ely, J. T. (2005). Controlling hyperglycemia as an adjunct to cancer therapy. Integrative Cancer Therapies, 4, 25-31. doi:10.1177/1534735404274167
    Lee, S. Y., Kurita, N., Yokoyama, Y., Seki, M., Hasegawa, Y., Okoshi, Y., & Chiba, S. (2014). Glucocorticoid-induced diabetes mellitus in patients with lymphoma treated with CHOP chemotherapy. Supportive Care in Cancer, 22, 1385-1390. doi:10.1007/s00520-013-2097-8
    Lleva, R. R., & Inzucchi, S. E. (2011). Hospital management of hyperglycemia. Current Opinion in Endocrinology, Diabetes, and Obesity, 18, 110-118. doi:10.1097/MED.0b013e3283447a6d
    Lukins, M. B., & Manninen, P. H. (2005). Hyperglycemia in patients administered dexamethasone for craniotomy. Anesthesia and Analgesia, 100, 1129-1133. doi:10.1213/01.ane.0000146943.45445.55
    Moghissi, E. S., Korytkowski, M. T., DiNardo, M., Einhorn, D., Hellman, R., & Hirsch, I. B. (2009). American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care, 32, 1119-1131. doi:10.2337/dc09-9029
    Morganstein, D. L., Tan, S., Gore, M., & Feher, M. D. (2012). Prevalence of diabetes in patients admitted to a cancer hospital. British Journal of Diabetes and Vascular Disease, 12, 178-180. doi:10.1177/1474651412459091
    National Adrenal Diseases Foundation. (2014). Quick reference for the most common symptoms of adrenal hormone replacement excess and deficiency. Retrieved from
    Oyer, D. S., Shah, A., & Bettenhausen, S. (2006). How to manage steroid diabetes in the patient with cancer. Journal of Supportive Oncology, 4, 479-483.
    Patel, G. W., Roderman, N., Lee, K. A., Charles, M. M., Nguyen, D., Beougher, P., … Casteneda, E. (2009). Sliding scale versus tight glycemic control in the noncritically ill at a community hospital. Annals of Pharmacotherapy, 43, 1774-1780. doi:10.1345/aph.1M331
    Pilkey, J., Streeter, L., Beel, A., Hiebert, T., & Li, X. (2012). Corticosteroid-induced diabetes in palliative care. Journal of Palliative Medicine, 15, 681-689.
    Rock, C. L., Doyle, C., Demark-Wahnefried, W., Meyerhardt, J., Courneya, K. S., Schwartz, A. L., … Gansler, T. (2012). Nutrition and physical activity guidelines for cancer survivors. CA: A Cancer Journal for Clinicians, 62, 242-274.
    Rocque, G. B., Barnett, A. E., Illig, L. C., Eickhoff, J. C., Bailey, H. H., Campbell, T. C., … Cleary, J. F. (2013). Inpatient hospitalization of oncology patients: Are we missing an opportunity for end-of-life care? Journal of Oncology Practice, 9, 51-54. doi:10.1200/JOP.2012.000698
    Romaguera, J. E., Fayad, L., Rodriguez, M. A., Broglio, K. R., Hagemeister, F. B., Pro, B., … Cabanillas, F. F. (2005). High rate of durable remissions after treatment of newly diagnosed aggressive mantle-cell lymphoma with rituximab plus hyper-CVAD alternating with rituximab plus high-dose methotrexate and cytarabine. Journal of Clinical Oncology, 23, 7013-7023. doi:10.1200/JCO.2005.01.1825
    Ruutu, T., Juvonen, E., Remberger, M., Remes, K., Volin, L., Mattsson, J., … Marrow, T. (2014). Improved survival with ursodeoxycholic acid prophylaxis in allogeneic stem cell transplantation: Long-term follow-up of a randomized study. Biology of Blood and Marrow Transplantation, 20, 135-138. doi:10.1016/j.bbmt.2013.10.014
    Ryken, T. C., McDermott, M., Robinson, P. D., Ammirati, M., Andrews, D. W., Asher, A. L., … Kalkanis, S. N. (2010). The role of steroids in the management of brain metastases: A systematic review and evidence-based clinical practice guideline. Journal of Neuro-Oncology, 96, 103-114. doi:10.1007/s11060-009-0057-4
    Shah, P., Cui, J., Busaidy, N. L., Sherman, S., & Lavis, V. R. (2008). Why is new hyperglycemia dangerous in a cancer hospital? Retrieved from
    Smiley, D., & Umpierrez, G. E. (2010). Management of hyperglycemia in hospitalized patients. Annals of the New York Academy of Science, 1212, 1-11. doi:10.1111/j.1749-6632.2010.05805.x
    Trigg, M. E., & Higa, G. M. (2010). Chemotherapy-induced nausea and vomiting: Antiemetic trials that impacted clinical practice. Journal of Oncology Pharmacy Practice, 16, 233-244. doi:10.1177/1078155209354655
    Umpierrez, G. E., Hellman, R., Korytkowski, M. T., Kosiborod, M., Maynard, G. A., & Montori, V. M. (2012). Management of hyperglycemia in hospitalized patients in non-critical care setting: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology and Metabolism, 97, 16-38. doi:10.1210/jc.2011-2098
    van Raalte, D. H., Ouwens, D. M., & Diamant, M. (2009). Novel insights into glucocorticoid-mediated diabetogenic effects: Towards expansion of therapeutic options? European Journal of Clinical Investigation, 39, 81-93. doi:10.1111/j.1365-2362.2008.02067.x
    Vu, K., Busaidy, N., Cabanillas, M. E., Konopleva, M., Faderl, S., Thomas, D. A., … Yeung, S. C. (2012). A randomized controlled trial of an intensive insulin regimen in patients with hyperglycemic acute lymphoblastic leukemia. Clinical Lymphoma, Myeloma, and Leukemia, 12, 355-362. doi:10.1016/j.clml.2012.05.004