Review article
NEW INSIGHTS IN STEROID DIABETES
TINA TIČINOVIĆ KURIR
; Split University Hospital Center, Department of Clinical Pathophysiology, Split, Croatia
JOŠKO BOŽIĆ
; University of Split School of Medicine, Department of Integrative Physiology, Split, Croatia
ANITA MARKOTIĆ
; University of Split School of Medicine, Department of Medical Chemistry and Biochemistry and, Split, Croatia
ANELA NOVAK
; Split University Hospital Center, Department of Internal Medicine, Split, Croatia
Abstract
Glucocorticoids (GC) are the cornerstone in the treatment of numerous chronic autoimmune and inflammatory diseases. GC treatment is accompanied by significant metabolic adverse effects, including insulin resistance, glucose intolerance and diabetes, visceral adiposity, dyslipidemia and skeletal muscle atrophy. GCs are the most common cause of drug-induced diabetes mellitus. However, not everyone treated with glucocorticoids develops diabetes. Predictors of development of diabetes are age, weight, family history of diabetes mellitus, or personal history of gestational diabetes. There is evidence that patients with decreased insulin secretory reserve are much more likely to develop diabetes. Diabetes from topical steroid use is uncommon, but high-dose steroids have been associated with significant hyperglycemia, including development of hyperglycemic hyperosmolar syndrome and even diabetic ketoacidosis in patients with type 1 diabetes mellitus. Several mechanisms contribute to the development of hyperglycemia and steroid-induced diabetes, including decreased peripheral insulin sensitivity, increased hepatic glucose production, and inhibition of pancreatic insulin production and secretion. Physicians treating patients with GCs should be aware of the induction of metabolic disturbances and should not solely rely on fasting measurements. In addition, our review indicates that insulin therapy could be considered when treating patients on GC therapy.
Keywords
glukokortikoidi; steroidni dijabetes; hiperglikemija; inzulinska rezistencija
Hrčak ID:
104099
URI
Publication date:
20.6.2013.
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