Steroid-Induced Diabetes Mellitus and Related Risk Factors in Patients With Neurologic Disease

Takuya Iwamoto, MS; Yoshiyuki Kagawa, PhD; Yutaka Naito, MD; Shigeki Kuzuhara, MD; Michio Kojima, PhD

Disclosures

Pharmacotherapy. 2004;24(4) 

In This Article

Abstract and Introduction

Abstract

Study Objective: To determine the frequency of steroid-induced diabetes mellitus (SDM) and the related risk factors in patients with neurologic diseases who receive high doses of steroids.
Design: Retrospective chart review.
Setting: Neurology ward of a university-affiliated hospital.
Patients: Twenty-five patients with neurologic diseases who received prednisolone 30-60 mg/day orally after breakfast for more than 2 weeks.
Measurements and Main Results: Plasma glucose concentrations were determined immediately before and 2 hours after each meal. Steroid-induced diabetes mellitus was diagnosed if the patient had either a fasting glucose concentration of 126 mg/dl or greater, or a random glucose concentration of 200 mg/dl or greater. The patients were divided into two groups on the basis of whether SDM had developed (13 patients) or not (12 patients). Ages, body mass indexes, cumulative total doses and daily doses of prednisolone, duration of therapy, and serum cholesterol and triglyceride concentrations were compared between the groups. Thirteen of the 25 patients were identified with SDM, and all of them had plasma glucose concentrations of 200 mg/dl or greater 2 hours after lunch. Mean age (59.1 ± 10.2 yrs) and cholesterol concentration after prednisolone treatment (226.8 ± 36.4 mg/dl) in the SDM group were significantly higher than those values in the non-SDM group (41.3 ± 18.0 yrs and 188.1 ± 27.2 mg/dl, respectively, p<0.01).
Conclusions: A close relationship among postprandial hyperglycemia, advanced age, and hypercholesterolemia is a characteristic of SDM in patients with neurologic diseases. Therefore, monitoring the plasma glucose concentration 2 hours after lunch may be useful to detect SDM in these patients.

Introduction

Steroids have been known to inhibit the production of cytokines concerned with the development of inflammatory foci.[1] Steroids also prevent the production of metalloprotease, which enables inflammatory cells to break down the blood-brain barrier.[2,3] Through these pharmacologic actions, steroids have been widely used in the treatment of neurologic diseases such as myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, and multiple sclerosis. Patients with neurologic diseases often receive high doses of steroids for years. These steroids usually are administered once/day after breakfast so as to fit their blood concentrations to the circadian rhythm levels of intrinsic steroid hormones.

An excess of steroids impairs the suppression of glucose production and stimulation of glucose utilization, which might cause diabetes mellitus or aggravate preexistent diabetes.[4,5] According to these mechanisms, abnormal glucose metabolism induced by steroids may reflect both fasting and postprandial hyperglycemia. The report that peripheral glucose metabolism was impaired in patients with myotonic dystrophy[6] suggests that glucose utilization is likely to decrease in patients with neuromuscular disorders. Diabetes mellitus is defined not only by fasting plasma glucose concentrations, but also by random glucose concentrations.[7] The Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Asia study in Japan demonstrated that more than 70% of diabetes mellitus cases were diagnosed based on postprandial hyperglycemia.[8] It was previously reported that when only fasting glucose concentrations were monitored to detect steroid-induced diabetes mellitus (SDM), the frequency of SDM was 46% in renal transplant recipients who received high-dose steroid regimens.[9] However, if the plasma glucose concentrations after a meal also are monitored in this patient population, the frequency of SDM may be higher than that reported. To our knowledge, few reports have investigated the postprandial plasma glucose concentrations in patients receiving high doses of steroids.

In this study, we monitored the daily plasma glucose concentrations and estimated the frequency of SDM in patients with neurologic diseases who received high doses of steroids. Furthermore, we investigated the risk factors for SDM in these patients.

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