Introduction: Glucocorticoid therapy (GCT) is one of the risk factors of carbohydrate metabolism disorders (CMD) in patents with systemic inflammatory diseases. CMD development is a concern not only with long-term therapy, but also during intensive short-term glucocorticoid (GC) administration, which can lead to different CMDs, including impaired glucose tolerance (IGT) and diabetes mellitus (DM).
Aim: To evaluate the prevalence of CMD after long-term and intensive GCT in patients with systemic lupus erythematosus (SLE), systemic vasculitis (SV) and chronic glomerulonephritis (CGN).
Patients and methods: The study included 165 patients, among them with SLE 53, SV 35 and CGN 67 patients. Ninety-eight patients received GC pulse-therapy (GCPT) (one series of three sessions), and 67 oral GCT (OGCT). All patients underwent standard clinical and laboratory evaluation, oral glucose tolerance test (OGTT), evaluation of C-peptide, HOMA-IR and HOMA-islet indices.
Results: CMDs developed less often in patients receiving GCPT compared to long-term OGCT (P=0.035). In patients receiving OGCT the most prevalent CMDs were IGT and DM in 21 (31.1%) and 19 (28.4%) patients respectively, which was significantly higher compared to patients in GCPT group (P=0.038 and P=0.049). In both groups of patients with DM and IGT baseline C-peptide and HOMA-IR before the treatment and OGTT was higher than in patients without CMD or with IFG, which indicates the presence of insulin resistance in this patient group. In DM patients a decrease of HOMA-islet index was observed in the first group from 13.96 before OGTT to 11.8 after glucose load and in the second group from 147 at baseline to 78.4 after the test.
Conclusion: GCT leads to IGT and DM in patients with increased insulin resistance both during GCPT and long-term OGCT. Long-term OGCT is associated with more CMDs compared to GCPT.
20 - 23 May 2017
European Society of Endocrinology