1998-P: QI Protocol for Management of Steroid-Induced Hyperglycemia in Hospitalized Patients Using Insulin

Introduction and Objective: Glucocorticoids are used in up to 10% of hospitalized adults, of which 56-86% experience hyperglycemia independent of diabetes. Until 2025, there was no protocol within TriHealth hospitals for managing steroid-induced hyperglycemia (SIHG). A protocol and accompanying Epic order set were developed to guide insulin selection based on steroid pharmacokinetics. Methods: A multidisciplinary team implemented provider education to accompany the SIHG order set. Table below outlines the protocol. A retrospective chart review was performed from February 1 through October 31, 2025, to assess safety, early performance, and identify opportunities for improvement. Results: A total of 59 patients were reviewed. Of those, 24 had a previous diagnosis of diabetes. Severe hyperglycemia (>250 mg/dL) and hypoglycemia (glucose 54-70 mg/dL) occurred in 47.46% and 3.4% of patients, respectively. Hyperglycemia occurred in 96% of diabetics. Only 34% and 41% of patients were selected appropriately for protocol use, and were initiated on the appropriate insulin regimen, respectively. Conclusion: SIHG protocol was associated with low hypoglycemia rates, but high hyperglycemia, especially in preexisting diabetics. Gaps included incorrect insulin selection/dosing, missed identification of eligible individuals, under-adjustment of insulin. This data implicates the need for protocol adjustments and increased education regarding appropriate order set utilization. Disclosure A. Vanaparti: None. C. Wirth: None. T. Alhayani: None. R. Teasdale: None. Y. Rangan: None.