title: Hyperglycemia related to high-dose glucocorticoid use in noncritically ill patients.
abstract: BACKGROUND
  Glucocorticoids commonly cause drug-induced diabetes. This association is well recognized but available evidence does not answer clinically relevant issues in subjects without diabetes.
  
  
  METHODS
  Thirty-five individuals without diabetes with a recent diagnosis of acute lymphoblastic leukemia or non-Hodgkin's lymphoma on high-dose glucocorticoid therapy were studied. Close systematic monitoring of fasting and postprandial glycemia and fasting insulin determinations, HOMA-insulin resistance and HOMA β-cell function were performed. The primary objective was to define the incidence of secondary diabetes in patients treated with high-dose glucocorticoids. Secondary objectives were to specify the intensity, the moment it appears and the evolution of hyperglycemia, in addition to the risk factors, mechanisms and impact of continuous and cyclical glucocorticoids on the development of hyperglycemia.
  
  
  RESULTS
  Mean age of patients was 38.4 ± 18.7 years. The incidence of diabetes was 40.6% and was found after the first week; half the time it occurred between the second and fourth. Two-thirds spontaneously normalized by eight weeks. Continuous glucocorticoid administration had a higher incidence of fasting hyperglycemia (P = 0.003). Mean peak insulin levels were significantly higher in cases of diabetes.
  
  
  CONCLUSIONS
  High-dose prednisone for 2 to 3 months produced an elevated incidence of diabetes, usually with mild hyperglycemia occurring between the second and fourth week, normalizing spontaneously in all cases. Hyperglycemia was more frequent with continuous doses and occurred in cases with increased insulin resistance. The clinical and therapeutic characteristics of our participants, who were otherwise healthy, could represent the clinical setting of many patients with illness from other medical areas that might require high doses of GC for six to twelve weeks.
authors.affiliation: Endocrinology Sevice, "Dr. José E. González" University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico.
authors.forename: Jose Gerardo
authors.initials: JG
authors.lastname: Gonzalez-Gonzalez
authors.affiliation: Endocrinology Sevice, "Dr. José E. González" University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico.
authors.forename: Leonor Guadalupe
authors.initials: LG
authors.lastname: Mireles-Zavala
authors.affiliation: Department of Internal Medicine, "Dr. José E. González" University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico.
authors.forename: Rene
authors.initials: R
authors.lastname: Rodriguez-Gutierrez
authors.affiliation: Hematology Service, "Dr. José E. González" University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico.
authors.forename: David
authors.initials: D
authors.lastname: Gomez-Almaguer
authors.affiliation: Endocrinology Sevice, "Dr. José E. González" University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico.
authors.forename: Fernando Javier
authors.initials: FJ
authors.lastname: Lavalle-Gonzalez
authors.affiliation: Endocrinology Sevice, "Dr. José E. González" University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico.
authors.forename: Hector Eloy
authors.initials: HE
authors.lastname: Tamez-Perez
authors.affiliation: Department of Internal Medicine, "Dr. José E. González" University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Gonzalez-Saldivar
authors.affiliation: Endocrinology Sevice, "Dr. José E. González" University Hospital and School of Medicine, Universidad Autónoma de Nuevo León, Ave. Madero y Gonzalitos s/n, Colonia Mitras Centro, Monterrey, Nuevo Leon 64460, Mexico.
authors.forename: Jesus Zacarias
authors.initials: JZ
authors.lastname: Villarreal-Perez
keywords: Diabetes; Drug-induced diabetes; Glucocorticoid; Glucocorticoid-induced diabetes; Hyperglycemia; Secondary diabetes
references.citation: Lupus. 2011 Oct;20(10):1027-34
references.pmid: 21659423
references.citation: Nephron Clin Pract. 2007;105(2):c54-7
references.pmid: 17135768
references.citation: Endocr Pract. 2009 Jul-Aug;15(5):469-74
references.pmid: 19454391
references.citation: Diabetes Care. 1997 Jul;20(7):1087-92
references.pmid: 9203442
references.citation: Clin Transplant. 2005 Aug;19(4):527-31
references.pmid: 16008600
references.citation: J Korean Med Sci. 2011 Feb;26(2):264-7
references.pmid: 21286019
references.citation: Postgrad Med. 1998 Nov;104(5):163-6, 171, 175-6
references.pmid: 9823393
references.citation: Diabetes Care. 2002 Mar;25(3):583-92
references.pmid: 11874952
references.citation: Endocr Pract. 2006 Jul-Aug;12(4):358-62
references.pmid: 16901792
references.citation: Ann Intern Med. 1993 Apr 1;118(7):529-39
references.pmid: 8442624
references.citation: J Clin Endocrinol Metab. 2012 Jan;97(1):16-38
references.pmid: 22223765
references.citation: Acta Med Croatica. 2002;56(1):35-8
references.pmid: 12455453
references.citation: Expert Opin Drug Saf. 2005 Nov;4(6):1097-109
references.pmid: 16255667
references.citation: J Clin Endocrinol Metab. 1982 Jan;54(1):131-8
references.pmid: 7033265
references.citation: Pharmacol Ther. 2002 Oct;96(1):23-43
references.pmid: 12441176
references.citation: Cleve Clin J Med. 2011 Nov;78(11):748-56
references.pmid: 22049542
references.citation: Diabetes Care. 2012 Jan;35 Suppl 1:S64-71
references.pmid: 22187472
references.citation: Diabetes Care. 2006 Dec;29(12):2728-9
references.pmid: 17130214
references.citation: Nephrol Dial Transplant. 2003 Jan;18(1):164-71
references.pmid: 12480976
references.citation: J Cardiovasc Pharmacol Ther. 2008 Dec;13(4):298-300
references.pmid: 19087951
references.citation: Pharmacotherapy. 2004 Apr;24(4):508-14
references.pmid: 15098806