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Case studies

Brought to you by Diabetes & Primary Care, the three mini-case studies presented below take you through what it is necessary to consider in identifying and managing steroid-induced hyperglycaemia. Each scenario provides a different set of circumstances that you could meet in your everyday practice. By actively engaging with them, you will feel more confident and empowered to manage effectively such problems in the future.

  1. American Diabetes Association (2020) 2. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes. Diabetes Care 43(Suppl 1): S14–S31
  2. WHO, IDF (2006) Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia: Report of a WHO/IDF consultation. Available at: https://bit.ly/2PtZbTu (accessed 05.03.21)
  3. Evans P, Sidaway-Lee K (2015) Clinical presentations and diagnosis of diabetes. Diabetes & Primary Care 17: 36–43 (https://bit.ly/38dSwDw)
  4. NHS England (2021) Healthier Your: NHS Diabetes Prevention Programme. Available at: https://bit.ly/3r94HIx (accessed 23.03.21)
  5. John WG, Hillson R, Alberti SG (2012) Use of haemoglobin A1c (HbA1c) in the diagnosis of diabetes mellitus. The implementation of World Health Organisation (WHO) guidance 2011. Practical Diabetes 29: 12–12a
  6. WHO (2011) Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus. Abbreviated Report of a WHO Consultation. Available at: https://bit.ly/2PyeSsR (accessed 05.03.21)
  7. NICE (2015) Type 2 diabetes in adults: management (NG28). Available at: https://www.nice.org.uk/guidance/ng28 (accessed 05.03.21)
  8. Chatterton A, Younger T, Fischer A, Khunti K (2012) Risk identification and interventions to prevent type 2 diabetes in adults at high risk: summary of NICE guidance. BMJ 345: 42–4
  9. Continho M, Gerstein HC, Wang Y, Yusuf S (1999) The relationship between glucose and incident cardiovascular events. Diabetes Care 22: 233–40
  10. UKPDS Group (1998) Intensive blood glucose control with sulphonylureas or insulin compared to conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 352: 837–53
  11. Selvin E, Steffes MW, Zhu H et al (2010) Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults. N Engl J Med 362: 800–11
  1. de Lusignan S, Sadek N, Mulnier H et al (2012) Miscoding, misclassification and misdiagnosis of diabetes in primary care. Diabet Med 29: 181–9
  1. NICE (2012) Type 2 diabetes: prevention in people at high risk (PH38). Available at: https://www.nice.org.uk/guidance/ph38 (accessed 05.03.21)
  2. Diabetes UK (2021) Type 2 Diabetes: Know Your Risk. Available at: https://riskscore.diabetes.org.uk/start (accessed 23.03.21)
  1. Section 1

    Elizabeth, age 82, had seen her GP with a bitemporal headache, jaw claudication and lethargy, and been diagnosed as having giant cell (temporal) arteritis. Prednisolone 40 mg once daily was commenced on recommendation of the ophthalmology team, and blood tests revealed markedly elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels. HbA1c was within normal range.

    Elizabeth’s symptoms rapidly resolved but, at a review appointment a few days later, a capillary blood glucose level was raised at 25 mmol/L. She reported symptoms of increased thirst and micturition. There was no previous history of diabetes. Prior to this episode of giant cell arteritis, Elizabeth had been in good health, with her only medication being amlodipine 5 mg once daily for hypertension. Her weight was 51 kg.

    What is your assessment of Elizabeth’s situation and how would you define this more clearly?

    • This response will be awarded full points automatically, but it can be reviewed and adjusted after submission.

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