Risk factors for steroid diabetes in rheumatic patients.
BACKGROUND
Steroid induced diabetes (SDM) has been known for a long time, but its pathophysiological mechanisms as well as its predisposing factors remain unknown.


METHODS
In order to investigate the different factors related to the development of steroid diabetes (SDM) in patients with rheumatic diseases, we studied 27 patients with SDM, and 27 age- and sex-matched controls who also received therapy with glucocorticoids. In every case, family history of DM, body mass index, associated treatment, steroid dose and treatment duration were studied; fasting serum insulin, "C" peptide, growth hormone and glucagon levels were measured.


RESULTS
All of the patients received prednisone. Cumulated prednisone dose was the only factor significantly associated with the development of SDM. Patients with SDM had a cumulated dose of 26.6 +/- 28 g (M +/- SD), while the control group received 11.6 +/- 11 g (p < 0.02) (odds ratio, 6.35). Serum insulin levels were not significantly different, but insulin/glucose ratio was lower in SDM (0.104 +/- 0.05) than in the control group (0.163 +/- 0.07) (p < 0.05).


CONCLUSIONS
These findings suggest that high cumulated prednisone dose may induce DM regardless of another hereditary or personal predisposing factor.
Departamento de Medicina Interna, Hospital de Especialidades, Centro Médico La Raza, Instituto Mexicano del Seguro Social, México, D.F.
C
C
Raúl Ariza-Andraca
L A
LA
Barile-Fabris
A C
AC
Frati-Munari
P
P
Baltazár-Montufar
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000139:chemically induced*; D005260:Female; D005905:Glyburide / Q000627:therapeutic use; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000009:adverse effects*; D012216:Rheumatic Diseases / Q000150:complications* / Q000188:drug therapy; D012307:Risk Factors
D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D007004:Hypoglycemic Agents; D007328:Insulin; D005905:Glyburide; D011241:Prednisone