Continuous Glucose Monitoring Profiles in Paeditric Patients Receiving High-dose Glucocorticoid Treatmeant

Intoduction: Glucocorticoids (GC) remain the first-line treatment for many autoimmune, inflammatory and allergic conditions, but the prevalence of glucocorticoid-induced hyperglycaemia (GIH) in paediatric patients has not been established. Furthermore, specific recommendations for the timing and frequency of glucose monitoring during high-dose GC therapy are also missing. Our objective was to describe the glycaemic patterns in children receiving high doses of systemic GC using continuous glucose monitoring (CGM) and to describe the risk factors for GIH. Methods: This prospective observational study was performed between December 2021 and December 2024 at the Department of Paediatrics of the Tartu University Children's Clinic. Paediatric patients, who received GC treatment due to an underlying condition at a dose of at least 1 mg/kg/day prednisolone-equivalent were monitored with a iPro 2 or a Guardian 4 CGM system during their GC treatment course. CGM data were analyzed retrospectively. The following parameters were evaluated: time in range (TIR, percentage of reading in the range 3.9-10 mmol/L) time above range (TAR, percentage of readings above 10 mmol/L) and mean sensor glucose (SG). Results: CGM profiles of 10 patients were analysed (2 boys, 8 girls). The average age of the participants was 10,5 years (range from 4 to 17 years). The average duration of glucose monitoring with CGM was 5 days (/- 2 days). Seven out of ten patients experienced GIH defined as SG above 10 mmol/L. The average coefficient of variation of the participants was 21% (range from 15 to 26%). Patients with GIH spent on average 1,5 hours per day with glucose values above 10 mmol/L which attributes to TAR of 6% ( +/- 9%). The highest SG values during 24 hours were observed between 16:00- 23:00 for patients receiving oral prednisolone and intravenous methylprednisolone. Discussion and conclusion: Two thirds of investigated subjects developed GC-induced hyperglycaemia. Participants experienced episodes of hyperglycaemia regardless of the route of GC administration. Higher SG measurements were registered during evening hours compared to early morning and this should be taken into account in the screening for GC-induced hyperglycaemia.