Background/Purpose: Since the efficacy of glucocorticoids for various rheumatic diseases was reported, glucocorticoids are still one of the important therapeutic agents in the current treatment of autoimmune disease. However, various adverse effects of glucocorticoids have been recognized and glucocorticoids-induced diabetes mellitus (GC-DM) is one of the critical systemic adverse effects of glucocorticoids. We conducted a single center retrospective cohort study to reveal risk factors for GC-DM. 

Methods: We enrolled inpatients with newly diagnosed rheumatic disease from April 2006 to February 2013 in our department. Patients with previously diagnosed DM, defined as hemoglobin A1c (HbA1c) more than or equal to 6.5% or fasting plasma glucose (FPG) more than or equal to 126 mg/dl on admission, were excluded from the study. Each patient’s baseline data included age, sex, underlying disease, smoking history, body mass index (BMI), family history of DM, FPG, HbA1c, eGFR, cholesterol, and triglyceride. We also collected the information of initial treatment including the maximum and the cumulative dosage of glucocorticoids and the concomitant use of methylprednisolone pulse therapy in four weeks. Primary end point of this study is the development of DM defined as fasting glucose not less than 126 mg/dl and/or postprandial glucose not less than 200 mg/dl at least twice after the initiation of glucocorticoids. We compared the characteristics and treatment status between GC-DM group and non DM group using paired t test and a Chi-square test. In order to identify independent risk factors for GC-DM, the extracted variables in the univariate analysis were entered into multivariate analysis using the logistic regression model.

Results: 26 male and 49 female patients (60.2± 17.1 years of age) consisting of 30 with systemic vasculitis, 15 with myositis and 11 with systemic lupus erythematosus were enrolled in the present study. The mean maximum dosage of glucocorticoids was 0.76 mg/kg/day and 20 patients (26.7 %) received methylprednisolone pulse therapy. 46 of 75 patients (61.6 %) developed GC-DM within 4 weeks. All patients with GC-DM showed the rise in postprandial blood glucose levels, while FPG levels of most patients were within normal range. The mean age and HbA1c levels at onset were significantly higher in GC-DM group than that in non-DM group (66.6 vs. 50.1 years p=0.002, 5.85 vs. 5.54 % p=0.034, respectively). No difference was found between two groups with the mode and dose of glucocorticoids. The patients with vasculitis developed GC-DM more frequently than those with SLE (73.3 % vs. 27.3 % p=0.006) while the mean age at disease onset is older in patients with vasculitis than those in patients with SLE (68.7 vs. 36.6 years p=0.008). In multivariate analysis, older age (more than or equal to 65 years) and higher levels of HbA1c (> 5.9%) were detected as independent risk factors for GC-DM (Odds ratio; 4.28 and 5.24, respectively).

Conclusion: Under the treatment with moderate or high dose of glucocorticoids, monitoring the postprandial glucose level is recommended particularly in patients with older age or higher levels of HbA1c for monitoring the development of GC-DM.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/risk-factors-for-glucocorticoids-induced-diabetes-in-patients-with-rheumatic-diseases/