title: Glucocorticoids and the risk for initiation of hypoglycemic therapy.
abstract: OBJECTIVE
  To quantify risk for the occurrence of hyperglycemia requiring initiation of hypoglycemic therapy in patients treated with oral glucocorticoids.
  
  
  METHODS
  A case-control study of enrollees in the New Jersey Medicaid program 35 years of age or older. The 11,855 case patients had newly initiated treatment with a hypoglycemic agent (oral or insulin) between 1981 and 1990. The 11,855 controls represented a random sample of other Medicaid enrollees.
  
  
  RESULTS
  In patients using oral glucocorticoids, the estimated relative risk for development of hyperglycemia requiring treatment was 2.23 (95% confidence interval, 1.92 to 2.59) as compared with nonusers. Risk increased with increasing average daily steroid dose, in hydrocortisone-equivalent milligrams; the odds ratio was 1.77 for 1 to 39 mg/d, 3.02 for 40 to 79 mg/d, 5.82 for 80 to 119 mg/d, and 10.34 for 120 mg/d or more. The estimated effects persisted after adjustment for a variety of potentially confounding demographic, health service utilization, and medication use variables.
  
  
  CONCLUSIONS
  The findings of this population-based study quantify the risk of developing hyperglycemia requiring hypoglycemic therapy after oral glucocorticoid use. The magnitude of risk increases substantially with increasing glucocorticoid dose. These findings demonstrate the utility of large-scale health claims databases in defining the risk of important adverse drug effects.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
authors.forename: J H
authors.initials: JH
authors.lastname: Gurwitz
authors.forename: R L
authors.initials: RL
authors.lastname: Bohn
authors.forename: R J
authors.initials: RJ
authors.lastname: Glynn
authors.forename: M
authors.initials: M
authors.lastname: Monane
authors.forename: H
authors.initials: H
authors.lastname: Mogun
authors.forename: J
authors.initials: J
authors.lastname: Avorn
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000628:therapy; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009515:New Jersey; D012306:Risk; D013223:Statistics as Topic; D014481:United States
chemical_list: D005938:Glucocorticoids