Purpose: Steroid usage may cause hyperglycaemia in non-diabetic patients. We aimed to detect the onset of hyperglycaemia and the best time for glucose measuring over a short time span (15 days) in non-diabetic patients who commenced moderate or high dose steroid therapy.
Methods: Electronic data of patients, who were commenced moderate or high dose steroid therapy (1560 mg prednisolone or equivalent dose methyl prednisolone) due to inflammatory rheumatologic diseases between January 2015 and December 2016, were retrospectively evaluated. The subjects who had confirmed diagnosis of DM were excluded. Seven point (morning fasting, pre-meal before breakfast, lunch, and dinner, and bedtime) capillary blood glucose measurements during the first 5 days of steroid therapy were evaluated. Results: 1750 premeal and postmeal glucose measurements were collected from 15 male (age 44±16 years) and 35 female (age 41±12) patients. Fasting blood glucose ≥126 mg/dl and random glucose ≥200 mg/dl were diagnosed with DM, while random glucose between 179 and 200 mg/dl was considered as hyperglycemia. 21 (%42) patients developed steroid induced overt hyperglycemia compatible with DM and 39 (% 78) developed hyperglycemia to a lesser extent. Mean fasting blood glucose was 88.04±9.9 mg/dl and hemoglobin A1c was 5.46±0.36% before steroid therapy. The highest glucose was detected postprandial on 3rd day of steroid therapy both in DM developers and non-DM developer hyperglycaemia group (234±29 vs 180±18 mg/dl, P<0.0001). DM developers and non-DM developers did not show significant difference in terms of steroid dose, age, BMI, baseline hemoglobin A1c, previous steroid therapy history, underlying rheumatologic disorder, or family history of DM.
Conclusions: Fasting blood glucose may be normal and postprandial hyperglycaemia may be present in endogenous steroid excess due to Cushing syndrome and exogenous steroid usage. It is not recommended to monitor glucose levels during low dose steroid therapy, while moderate or high dose steroid therapy demands follow-up. It is especially important in outpatients to detect the best time for measurement. We showed that the highest values were postprandial levels on 3rd day of therapy in patients taking moderate-high dose of steroid. As a result we recommend measuring postprandial instead of fasting glucose levels during first 3 days of moderate-high dose of steroid therapy.
19 - 22 May 2018
European Society of Endocrinology