How should rheumatologists manage glucocorticoid-induced hyperglycemia?

Abstract

Glucocorticoid-induced hyperglycemia (GIH) is an important complication to be managed by rheumatologists as it can affect morbidity and mortality of patients. Before administration of glucocorticoids, risk for the development of GIH should be assessed in every patient. A meta-analysis identified male gender, older age, family history of diabetes mellitus, current smoking history, past history of hypertension, higher body mass index, higher fasting plasma glucose (PG) and higher hemoglobin A1c (HbA1c) levels as risk factors for GIH. Then, rheumatologists need to carefully monitored PG levels including 2-h after meals because glucocorticoids particularly affect postprandial glucose metabolism. Fasting PG level ≥ 126 mg/dL and/or post-meal PG level ≥ 200 mg/dL are considered as GIH regardless of HbA1c level. Treatment strategy for GIH should center on insulin injection since the effectiveness of oral hypoglycemic agents for GIH has been uncertain. But, rheumatologists may try oral hypoglycemic agents in advance of insulin therapy for mild GIH, whereas diabetologists should be consulted in case of intractable GIH. More strict control of GIH could be possible using intensive insulin protocol. Rheumatologists are encouraged to be interested in the management of GIH for providing patients superior care, working closely with diabetologists.

Keywords:

• Diabetes mellitus
• glucocorticoid
• hyperglycemia
• insulin
• steroid

Conflict of interest

A. N. has received honoraria from Sanofi, Mitsubishi Tanabe Pharma, Daiichi Sankyo, Eli Lilly Japan, MSD, Novo Nordisk Pharma, Novartis Pharma, AstraZeneca, Takeda Pharmaceutical, Astellas, Kowa Pharmaceutical, Ono, Nippon Boehringer Ingelheim, and Taisho Toyama Pharmaceutical, and has obtained research support from Mitsubishi Tanabe Pharma, Daiichi Sankyo, MSD, Novo Nordisk Pharma, Novartis Pharma, AstraZeneca, Dainippon Sumitomo Pharma, LifeScan Japan, and Taisho Toyama Pharmaceutical.

T. A. has honoraria from Mitsubishi Tanabe Pharma, Chugai Pharma, Astellas, Takeda Pharma, Pfizer, AbbVie, Eisai, Daiichi Sankyo, Bristol-Myers Squibb, UCB Japan and Eli Lilly, consultancy fees form AstraZeneca, MEDICAL & BIOLOGICAL LABORATORIES, Pfizer, AbbVie, Ono Pharma, Novartis Pharma and Nippon Boehringer Ingelheim and research funding from Astellas, Takeda Pharma, Mitsubishi Tanabe Pharma, Chugai Pharma, Daiichi Sankyo, Otsuka Pharma, Pfizer and Alexion.

The other authors state that they have no conflict of interest.

Acknowledgment

No specific funding was received to carry out the work described in this manuscript.