Background/Aims: Glucocorticoids are associated with a number of side effects including the development of new-onset hyperglycemia or diabetes. The diagnosis and treatment of glucocorticoid-induced hyperglycemia are surprisingly undervalued by many health-care professionals, probably due to the lack of quality studies that assess specific reasons for and prevention of hyperglycemia. The aim of this meta-analysis was to evaluate the long-term incidence of glucocorticoid-induced hyperglycemia and diabetes in nondiabetic patients who received glucocorticoid treatment. Methods: We searched Medline, Embase, and the Cochrane Library (Central) until January 2014 for studies in which subjects received systematic glucocorticoid treatment and which evaluated whether subjects developed hyperglycemia or were diagnosed with diabetes following treatment. The primary outcome for this analysis was the incidence of hyperglycemia and the secondary outcome was the frequency of diabetes. Results: We identified 13 studies that met our inclusion criteria; 12 of the studies were retrospective or observational in design. We found that the rate at which patients developed glucocorticoid-induced hyperglycemia or diabetes was 32.3% (p = 0.003) and 18.6% (p = 0.002), respectively. Conclusions: Our meta-analysis indicated that glucocorticoid-induced hyperglycemia occurs fairly frequently and points to the need for the design of prospective, randomized, controlled studies to further investigate and better understand this medical problem.

Keywords:
Hyperglycemia, Diabetes, Glucocorticoid, Steroids, Glucocorticoid-induced hyperglycemia
1.
Perez A, Jansen-Chaparro S, Saigi I, Bernal-Lopez MR, Minambres I, Gomez-Huelgas R: Glucocorticoid-induced hyperglycemia. J Diabetes 2014;6:9-20.
2.
Donihi AC, Raval D, Saul M, Korytkowski MT, DeVita MA: Prevalence and predictors of corticosteroid-related hyperglycemia in hospitalized patients. Endocr Pract 2006;12:358-362.
3.
Gonzalez-Gonzalez JG, Mireles-Zavala LG, Rodriguez-Gutierrez R, Gomez-Almaguer D, Lavalle-Gonzalez FJ, Tamez-Perez HE, Gonzalez-Saldivar G, Villarreal-Perez JZ: Hyperglycemia related to high-dose glucocorticoid use in noncritically ill patients. Diabetol Metab Syndr 2013;5:18.
4.
Kwon S, Hermayer KL: Glucocorticoid-induced hyperglycemia. Am J Med Sci 2013;345:274-277.
5.
Angelopoulos TP, Tentolouris NK, Bertsias GK, Boumpas DT: Steroid-induced diabetes in rheumatologic patients. Clin Exp Rheumatol 2014;32:126-130.
6.
Tatsuno I, Sugiyama T: Glucocorticoid-induced diabetes mellitus is a risk for vertebral fracture during glucocorticoid treatment. Diabetes Res Clin Pract 2011;93:e18-e20.
7.
Pagano G, Cavallo-Perin P, Cassader M, Bruno A, Ozzello A, Masciola P, Dall'omo AM, Imbimbo B: An in vivo and in vitro study of the mechanism of prednisone-induced insulin resistance in healthy subjects. J Clin Invest 1983;72:1814-1820.
8.
Rizza RA, Mandarino LJ, Gerich JE: Cortisol-induced insulin resistance in man: impaired suppression of glucose production and stimulation of glucose utilization due to a postreceptor detect of insulin action. J Clin Endocrinol Metab 1982;54:131-138.
9.
Abdelmannan D, Tahboub R, Genuth S, Ismail-Beigi F: Effect of dexamethasone on oral glucose tolerance in healthy adults. Endocr Pract 2010;16:770-777.
10.
Clore JN, Thurby-Hay L: Glucocorticoid-induced hyperglycemia. Endocr Pract 2009;15:469-474.
11.
Moga C, Guo B, Schopflocher D, Harstall C: Development of a Quality Appraisal Tool for Case Series Studies Using a Modified Delphi Technique. Edmonton, Institute of Health Economics, 2012.
12.
McConnell EM, Bell PM, Hadden DR, McCance DR, Sheridan B, Atkinson AB: Prevalence of diabetes and impaired glucose tolerance in adult hypopituitarism on low dose oral hydrocortisone replacement therapy. Clin Endocrinol (Oxf) 2001;54:593-599.
13.
Ito S, Ogishima H, Kondo Y, Sugihara M, Hayashi T, Chino Y, Goto D, Matsumoto I, Sumida T: Early diagnosis and treatment of steroid-induced diabetes mellitus in patients with rheumatoid arthritis and other connective tissue diseases. Mod Rheumatol 2014;24:52-59.
14.
Alavi A, Lowe J, Walsh S, Juurlink D, Mortaz-Hedjri S, Shear NH: Corticosteroid-induced hyperglycemia is increased 10-fold in patients with pemphigus. Int J Dermatol 2012;51:1248-1252.
15.
Udoetuk JD, Dai Y, Ying GS, Daniel E, Gangaputra S, Rosenbaum JT, Suhler EB, Thorne JE, Foster CS, Jabs DA, Levy-Clarke GA, Nussenblatt RB, Kempen JH; Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study Research Group: Risk of corticosteroid-induced hyperglycemia requiring medical therapy among patients with inflammatory eye diseases. Ophthalmology 2012;119:1569-1574.
16.
Burt MG, Willenberg VM, Petersons CJ, Smith MD, Ahern MJ, Stranks SN: Screening for diabetes in patients with inflammatory rheumatological disease administered long-term prednisolone: a cross-sectional study. Rheumatology (Oxford) 2012;51:1112-1119.
17.
Ha Y, Lee KH, Jung S, Lee SW, Lee SK, Park YB: Glucocorticoid-induced diabetes mellitus in patients with systemic lupus erythematosus treated with high-dose glucocorticoid therapy. Lupus 2011;20:1027-1034.
18.
Kim SY, Yoo CG, Lee CT, Chung HS, Kim YW, Han SK, Shim YS, Yim JJ: Incidence and risk factors of steroid-induced diabetes in patients with respiratory disease. J Korean Med Sci 2011;26:264-267.
19.
Uzu T, Harada T, Sakaguchi M, Kanasaki M, Isshiki K, Araki S, Sugiomoto T, Koya D, Haneda M, Kashiwagi A, Yamauchi A: Glucocorticoid-induced diabetes mellitus: prevalence and risk factors in primary renal diseases. Nephron Clin Pract 2007;105:c54-c57.
20.
Pilkey J, Streeter L, Beel A, Hiebert T, Li X: Corticosteroid-induced diabetes in palliative care. J Palliat Med 2012;15:681-689.
21.
Panthakalam S, Bhatnagar D, Klimiuk P: The prevalence and management of hyperglycaemia in patients with rheumatoid arthritis on corticosteroid therapy. Scott Med J 2004;49:139-141.
22.
Iwamoto T, Kagawa Y, Naito Y, Kuzuhara S, Kojima M: Steroid-induced diabetes mellitus and related risk factors in patients with neurologic diseases. Pharmacotherapy 2004;24:508-514.
23.
Blackburn D, Hux J, Mamdani M: Quantification of the risk of corticosteroid-induced diabetes mellitus among the elderly. J Gen Intern Med 2002;17:717-720.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.