2013 年 39 巻 7 号 p. 395-405
The influence of pharmacist-supported insulin therapy on the safety and efficacy of blood glucose management in steroid therapy for hematologic malignancies complicated by diabetes in collaborative drug therapy management was examined. At the same time, an insulin dose-predicting factor required for blood glucose control was investigated. Changes in the blood glucose level after steroid administration were significantly decreased on medication support by a pharmacist compared to those in blood glucose control performed by a physician alone: the median (range) blood glucose level before breakfast, 138.6 (99.00 - 189.0) mg/dL vs 156.4 (111.2 - 204.6) mg/dL (P = 0.13); before lunch, 198.5 (128.7 - 307.0) mg/dL vs 240.9 (157.7 - 410.5) mg/dL (P < 0.01); before supper, 232.9 (161.7 - 329.8) mg/dL vs 311.5 (157.4 - 387.9) mg/dL (P < 0.01); before sleep, 247.5 (164.9 - 338.7) mg/dL vs 293.3 (174.7 - 345.9) mg/dL (P < 0.01), respectively. An index of daily glycemia excursions, Schlichtkrull M120 value, was also significantly decreased: 30.27 (5.96 - 66.04) vs 58.63 (9.21 - 93.68) (P < 0.001), respectively. The insulin dose was inversely correlated with the prednisolone dose (correlation coefficient: -0.511. P = 0.021), but no correlation with any other factor (dexamethasone dose, age, body mass index, and HbA1c (JDS ) was noted. The findings suggest that meticulous dose control in consideration of a patient’s insulin sensitivity is essential for blood glucose control using insulin in steroid therapy, and cooperation between pharmacists and physicians facilitates precise blood glucose control, leading to safe and effective insulin therapy.