Management of Steroid-induced Hyperglycemia.

Suh,  Sunghwan; Park,  Mi Kyoung

doi:2016.17.3.174

J Korean Diabetes > Volume 17(3); 2016 > Article

Focused Issue

The Journal of Korean Diabetes 2016;17(3):174-184.
DOI: https://doi.org/10.4093/jkd.2016.17.3.174 Published online October 13, 2016.

스테로이드 투여환자의 혈당관리

서성환, 박미경

Management of Steroid-induced Hyperglycemia.

Sunghwan Suh, Mi Kyoung Park

Division of Endocrinology and Metabolism, Department of Internal Medicine, Dong-A University Medical Center, Busan, Korea. pmk02@dau.ac.kr

Abstract

Steroids are widely used as potent anti-inflammatory and immunosuppressive drugs to treat a wide range of diseases. However, they are also associated with a number of side effects including new-onset hyperglycemia in patients without a history of diabetes mellitus or severely uncontrolled hyperglycemia in patients with known diabetes mellitus. This negative effect is believed to be caused by a variety of factors, including increased insulin resistance, increased glucose intolerance, reduced beta-cell mass from beta-cell dysfunction, and increased hepatic insulin resistance leading to impaired suppression of hepatic glucose production. Steroid-induced hyperglycemia is important in clinical practice because it has been associated with deleterious effect on prognosis. However, there is no scientific evidence regarding the consequences of corticosteroid-induced hyperglycemia and clinical studies investigating the effects of prevention and correction of the condition are lacking. Similar to non-steroid-related diabetes, the principles of early detection and risk factor modification apply. Challenges in the management of steroid-induced diabetes stem from wide fluctuations in post-prandial hyperglycemia and the lack of clearly defined treatment protocols. Together with, or after, life style measures, hypoglycemic drug with important insulin sensitizer effects is indicated. Other oral hypoglycemic drugs or insulin therapy can be considered as the drug of choice. These treatments may provide additional long-term survival benefit and improve glycemic control.

Key Words: Corticosteroids, Diabetes mellitus, Hyperglycemia