title: Steroid-induced diabetes mellitus in systemic lupus erythematosus patients: analysis from a Malaysian multi-ethnic lupus cohort.
abstract: OBJECTIVE
  Systemic lupus erythematosus (SLE) is a chronic autoimmune disease and glucocorticoid is the mainstay of treatment in SLE. The reported incidence of steroid-induced diabetes mellitus (SDM) ranged between 1-53%. We sought to investigate the prevalence and associated factors of SDM in patients with SLE.
  
  
  METHODS
  A total of 100 SLE patients attending the Nephrology/SLE and Rheumatology Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC) who received corticosteroid treatment were recruited. The diagnosis of diabetes mellitus was based on the 2010 American Diabetes Association's criteria. Prevalent cases of SDM were also included. Statistical analysis was performed to determine the factors associated with SDM.
  
  
  RESULTS
  Thirteen of them (13%) developed SDM, with the median onset of diagnosis from commencement of glucocorticoid treatment being 8 years (range 0.5-21 years). Although only seven Indians were recruited into the study, three of them (42.9%) had SDM compared to Malays (9.3%) and Chinese (12.8%) (P ≤ 0.05). Univariate and multivariate analysis showed that higher numbers of system or organ involvement in SLE, abdominal obesity, hypertriglyceridemia and daily prednisolone of ≥ 1 mg/kg/day were the important associated factors of SDM (P ≤ 0.05). Meanwhile, hydroxychloroquine (HCQ) use was associated with reduced SDM prevalence (P < 0.05).
  
  
  CONCLUSIONS
  The prevalence of SDM among SLE patients was 13% and Indians were more prone to develop SDM compared to other races. Higher numbers of system involvement, abdominal obesity, hypertriglyceridemia and the use of oral prednisolone of ≥ 1 mg/kg/day were associated with SDM, while HCQ use potentially protects against SDM.
authors.affiliation: Rheumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Syahrul Sazliyana
authors.initials: SS
authors.lastname: Shaharir
authors.affiliation: Nephrology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Abdul Halim Abdul
authors.initials: AH
authors.lastname: Gafor
authors.affiliation: Rheumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Mohd Shahrir Mohamed
authors.initials: MS
authors.lastname: Said
authors.affiliation: Nephrology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: Norella C T
authors.initials: NC
authors.lastname: Kong
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects* / Q000627:therapeutic use*; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D002681:China / Q000208:ethnology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000139:chemically induced* / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000627:therapeutic use; D015228:Hypertriglyceridemia / Q000150:complications; D007194:India / Q000208:ethnology; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000453:epidemiology / Q000208:ethnology*; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056128:Obesity, Abdominal / Q000150:complications; D011239:Prednisolone / Q000009:adverse effects* / Q000627:therapeutic use*; D015995:Prevalence; D044469:Racial Groups; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D006886:Hydroxychloroquine; D011239:Prednisolone
keywords: SLE drug treatment; clinical aspects; systemic lupus erythematous