title: Screening for diabetes in patients with inflammatory rheumatological disease administered long-term prednisolone: a cross-sectional study.
abstract: OBJECTIVE
  The aim of the study was to assess the effect of long-term prednisolone on fasting and post-glucose load glucose concentration in patients with inflammatory rheumatological disease. We hypothesized that prednisolone would predominantly increase post-glucose load glucose concentration and that fasting glucose would have poor sensitivity as a screening test for diabetes in patients receiving chronic prednisolone therapy.
  
  
  METHODS
  In a cross-sectional study of subjects with inflammatory rheumatological disease but without known diabetes, 60 subjects [age = 70 (±10) years, 62% female] who were receiving chronic (>6 months) prednisolone [6.5 (±2.1) mg/day] (Group 1) and 58 controls [age = 70 (±11) years, 62% female] who had not received oral glucocorticoids for at least 6 months (Group 2) underwent an oral glucose tolerance test.
  
  
  RESULTS
  Fasting glucose was significantly lower [5.0 (±0.1) vs. 5.3 (±0.1) mmol/l, P = 0.02) and post-glucose load glucose concentration significantly higher [8.0 (±0.4) vs. 6.8 (±0.3) mmol/l, P = 0.02] in Group 1 than in Group 2. In a multiple regression analysis, glucocorticoid use (P = 0.004) and log CRP (P = 0.02) were independently associated with fasting glucose, while waist circumference (P = 0.01), but not glucocorticoid use, was independently associated with post-glucose load glucose concentration. A fasting glucose ≥5.6 mmol/l had 33 and 83% sensitivity for diabetes in Groups 1 and 2, respectively.
  
  
  CONCLUSIONS
  There is discordance between a reduced fasting and increased post-glucose load glucose concentration in rheumatological patients on long-term prednisolone. Therefore fasting glucose has poor sensitivity to screen for diabetes in prednisolone-treated patients. Treatment of prednisolone-induced hyperglycaemia should be directed at the postprandial period. Trial registration. Australian New Zealand Clinical Trials Registry, http://www.anzctr.org.au/, ACTRN12607000540415.
authors.affiliation: Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Daw Park, Adelaide 5041, Australia. morton.burt@health.sa.gov.au
authors.forename: Morton G
authors.initials: MG
authors.lastname: Burt
authors.forename: Venecia M
authors.initials: VM
authors.lastname: Willenberg
authors.forename: Carolyn J
authors.initials: CJ
authors.lastname: Petersons
authors.forename: Malcolm D
authors.initials: MD
authors.lastname: Smith
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ahern
authors.forename: Stephen N
authors.initials: SN
authors.lastname: Stranks
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced* / Q000175:diagnosis*; D004305:Dose-Response Relationship, Drug; D005215:Fasting; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D005951:Glucose Tolerance Test / Q000379:methods; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced / Q000175:diagnosis; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects*; D011446:Prospective Studies; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy*; D012680:Sensitivity and Specificity; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D005938:Glucocorticoids; D006442:Glycated Hemoglobin; D011239:Prednisolone; C517652:hemoglobin A1c protein, human