HIGH-DOSE GLUCOCORTICOIDS TREATMENT DOES NOT INDUCE SEVERE HYPERGLYCEMIA IN YOUNG PATIENTS WITH AUTOIMMUNE DISEASES BY CGMS.
Endocr Pract. 2017 Nov 06;:
Authors: Zhou Y, Zhao Y, Yuan T, Jiang N, Dong Y, Yang Y, Wang L, Zhao J, Min L, Zhao W
INTRODUCTION: High-dose glucocorticoids (HDG) are used in the treatment of autoimmune diseases. Glucocorticoids-induced hyperglycemia (GIH) is often described in elderly patients. In young patients with autoimmune diseases, however, the risk for GIH has not been well characterized.
METHODS: Twenty-four inpatients (median age 32 years (interquatile range 25-42)) with exacerbations of autoimmune diseases, receiving 1-2mg/kg/day prednisone or equivalent methylprednisone, were recruited. Fourteen subjects were naive to glucocorticoids (group 1) and 10 subjects were on glucocorticoids maintenance (≤15mg/day prednisone at least 3 months) (group 2) prior to HDG. All subjects were monitored by continuous glucose monitoring system (CGMS) for 3 days.
RESULTS: GIH developed in 21 subjects (91%), 11/13 in group 1 and 10/10 in group 2. The main peak of glucose excursion (128.7 ±6.4 mg/dl (group 1) and 143.9±10.0 mg/dl (group 2) occurred at 2-3PM. Another peak occurred before sleep. Two-hour mean postprandial glucose levels were normal in both groups: breakfast, 105.0±28.4 vs 125.6±24.4 mg/dl, p=0.065; Lunch, 115.7±21.1 vs 135.9±29.0 mg/dl, p=0.082; Dinner, 122.8±18.5 vs 137.8±26.4 mg/dl, p=0.144 in group 1 and 2 respectively. There was a positive association between pretreatment Hemoglobin A1C and peak glucose levels (p<0.0001). Notably, 35% of our subjects experienced early morning hypoglycemia (65.2 ± 2.8mg/dl).
CONCLUSIONS: In hospitalized young patients with autoimmune diseases, CGMS data revealed that short-term consistent HDG treatment induced mild hyperglycemia, peaking in the early afternoon and before sleep. Early morning hypoglycemia was found in 35%.
ABBREVIATIONS: GCs = glucocorticoids; HDG = high-dose glucocorticoids; A1C = Hemoglobin A1C; GA = Glycated Albumin; FBG = fasting blood glucose; IG = interstitial glucose; BG = blood glucose; GIH = Glucocorticoids-induced hyperglycemia; HOMA-IR = Homeostasis Model Assessment-Insulin Resistance; CGMS = continuous glucose monitoring system; AUC = the area under the curve; MODD = absolute means of daily differences; LAGE = the largest amplitude of glycemic excursions; BMI = body mass index; DM = diabetes mellitus; SLE = systemic lupus erythematosus; IQR = interquartile range; HR = hazard ratio; PUMCH = Peking Union Medical College Hospital.
PMID: 29106815 [PubMed - as supplied by publisher]