title: Fasting plasma glucose levels predict steroid-induced abnormal glucose metabolism in patients with non-diabetic chronic kidney disease: a prospective cohort study.
abstract: OBJECTIVE
  Glucocorticoids-induced abnormal glucose metabolism (AGM) is a common medical problem in patients with non-diabetic chronic kidney disease (CKD). However, little information is available regarding the prediction of steroid-induced AGM in this patient population.
  
  
  METHODS
  In this prospective cohort study, we consecutively enrolled 303 non-diabetic CKD patients with fasting plasma glucose (FPG) levels <5.6 mmol/l and normal oral glucose tolerance test (OGTT). OGTT was performed every 3 months during glucocorticoid treatment to identify new-onset AGM, and patients were followed for 12 months post steroid withdrawal.
  
  
  RESULTS
  During 593 person-years, there were 107 incident cases of steroid-induced AGM (18/100 person-year), including 55 (51.4%) diabetes and 52 (48.6%) pre-diabetes. In a multivariate model, each millimole increase per liter in FPG enhanced the risk of AGM by 4.6-fold (hazard ratio 4.58, 95% confidence interval, 2.67-7.83). After adjusting other risk factors, a progressively increased risk of AGM or DM was observed in patients with FPG levels ≥4.8 mmol/l, as compared with those whose levels were ≤4.3 mmol/l (p for trend <0.001). Furthermore, a greater increase in FPG level (≥0.3 mmol/l) during the first 3 months of glucocorticoid treatment was associated with an increased risk for future diabetes. For predicting steroid-induced diabetes, the area under the receiver-operating characteristic curve was 0.90 for the combination of FPG and changes in FPG levels at month 3.
  
  
  CONCLUSIONS
  Higher-normal FPG and a greater increase in FPG levels during glucocorticoid treatment may help to identify non-diabetic CKD patients at increased risk of steroid-induced AGM or diabetes.
authors.affiliation: National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
authors.forename: Xiaobing
authors.initials: X
authors.lastname: Yang
authors.forename: Xin
authors.initials: X
authors.lastname: Lin
authors.forename: Tao
authors.initials: T
authors.lastname: Lu
authors.forename: Pingyan
authors.initials: P
authors.lastname: Chen
authors.forename: Xiaobin
authors.initials: X
authors.lastname: Wang
authors.forename: Fan Fan
authors.initials: FF
authors.lastname: Hou
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019540:Area Under Curve; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000453:epidemiology; D005215:Fasting / Q000097:blood*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D005951:Glucose Tolerance Test; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000139:chemically induced / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000188:drug therapy; D018570:Risk Assessment; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D005938:Glucocorticoids; D014280:Triglycerides