Corticothérapie et diabète

Gagliardi, Laura; Jeunne, Claire Le

doi:10.1016/j.lpm.2012.01.008

Cited by 6 publications

(5 citation statements)

References 36 publications

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“…31 Glucocorticoids' intake can have a direct link to the development of DM in patients with SLE. 33 In line with our study, Appenzeller et al 34 reported thyroid disorders in 6.1% patients with SLE. A meta-analysis in 2018 demonstrated that SLE is significantly associated with increased risk of hypothyroidism and subclinical hypothyroidism with little influence on hyperthyroidism and subclinical hyperthyroidism.…”

Section: Discussionsupporting

confidence: 91%

Comorbidities among Egyptian systemic lupus erythematosus: The COMOSLE-EGYPT study

et al. 2022

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Objective To study the prevalence and impact of comorbidities among a cohort of patients with systemic lupus erythematosus (SLE). Methods This study is retrospective, multicenter including 902 Egyptian patients with SLE. Medical records were reviewed for demographic data, clinical characteristics, routine laboratory findings, immunological profile, and medications. Moreover, SLE Disease Activity Index (SLEDAI), and the Systemic Lupus International Collaborating Clinics/American College Rheumatology Damage Index scores were calculated. Results Comorbidities were found in 75.5% of the studied group with hypertension and dyslipidemia as the most frequent comorbidities (43.1% and 40.1%, respectively), followed by sicca features, avascular necrosis, diabetes, osteoporosis and renal failure (11.5%,9%, 9%,8.9%, and 7.1%, respectively). Multivariate regression model showed statistically significant relation between the presence of comorbid condition and each of age ( P = 0.006), disease duration ( P = 0.041), SLEDAI at onset ( P < 0.001), cyclophosphamide intake ( P = 0.001), and cumulative pulse intravenous methylprednisone ( P < 0.001). Also, when adjusted to age and sex, those with multiple comorbid conditions had 18.5 increased odds of mortality compared to those without comorbidities (odds ratio (OR), 95% confidence interval (CI) = 18.5 (6.65–51.69)]. Conclusion Patients with SLE suffer from several comorbidities, with an increasing risk with age, longer disease duration, higher SLEDAI at onset, cyclophosphamide intake and cumulative pulse intravenous methylprednisone. Risk of mortality is exponentiated with multiple comorbidities.

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Section: Discussionsupporting

confidence: 91%

Comorbidities among Egyptian systemic lupus erythematosus: The COMOSLE-EGYPT study

et al. 2022

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“…Some of the risk factors for corticosteroid-induced diabetes are the same as those for type 2 diabetes: age, family history of diabetes, previous gestational diabetes, and abdominal obesity. It is known that the drug use duration and the cumulative dose used are direct predictors of higher risk for diabetes [ 79 ].…”

Section: Methodsmentioning

confidence: 99%

Dexamethasone in the era of COVID-19: friend or foe? An essay on the effects of dexamethasone and the potential risks of its inadvertent use in patients with diabetes

Alessi

Oliveira

Schaan

et al. 2020

Diabetol Metab Syndr

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Background The disclosure in the media of a benefit with the use of dexamethasone in patients with COVID-19 infection sets precedents for self-medication and inappropriate use of corticosteroids. Methods This is a critical interpretive synthesis of the data available in the literature on the effects of the use of corticosteroids and the impact that their indiscriminate use may have on patients with diabetes. Reviews and observational and experimental studies published until June 18, 2020 were selected. Results Corticosteroids are substances derived from cholesterol metabolism that interfere with multiple aspects of glucose homeostasis. Interactions between corticoid receptors and target genes seem to be among the mechanisms responsible for the critical functions of glucocorticoids for survival and anti-inflammatory effects observed with these medications. Corticosteroids increase hepatic gluconeogenesis, reduce peripheral use of glucose and increase insulin levels. Previous studies have shown that glucocorticoids have a pro-adipogenic function, increasing deposition of abdominal fat, and lead to glucose intolerance and hypertriglyceridemia. In addition, these drugs play a role in controlling liver metabolism and can lead to the development of hepatic steatosis. Glucocorticoids reduce the recruitment of osteoblasts and increase the number of osteoclasts, which results in increased bone resorption and greater bone fragility. Moreover, these medications cause water and sodium retention and increase the response to circulating vasoconstrictors, which results in increased blood pressure levels. Chronic or high-dose use of corticosteroids can, by itself, lead to the onset of diabetes. For those who were already diagnosed with diabetes, studies show that chronic use of corticosteroids leads to a 94% higher risk of hospitalization due to diabetes complications. In addition to the direct effects on glycemic control, the effects on arterial pressure control, lipids and bone metabolism also have a potential for severe consequences in patients with diabetes. Conclusion Fear and uncertainty toward a potentially serious infection may lead people to self-medication and the inappropriate and abusive use of corticosteroids. More than ever, it is necessary for health professionals to be alert and able to predict damages related to the use of these drugs, which is the first step to minimize the potential damages to come.

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“…Les principales mesures adjuvantes à une corticothérapie systémique prolongée ne font l'objet d'aucun consensus au sein de la communauté interniste française [69]. Après une revue de la littérature et une compréhension de certains mécanismes physiopathologiques, on peut proposer une surveillance avec des mesures préventives récapitulés dans le tableau I [70].…”

Section: Resultsunclassified

“…Surveillance et mesures préventivesSurveillance tensionnelle Pas de restriction hydrosodée systématique (à prévoir si HTA préexistante) Contrôle des apports caloriques Athérome Dépistage et contrôle des facteurs de risques cardiovasculaires +++ Suivi régulier des marqueurs cardiovasculaires : bilan lipidique, HbAIc si diabète Risques cardiovasculaires immédiats des bolus (troubles du rythme et SCA) Chez tous les patients, avant bolus : PA, kaliémie, créatinine, ECG Pas d'apport de potassium systématique (sauf si hypokaliémie préexistante ou prise concomitante de traitement hypokaliémiant) Discuter antiagrégant plaquettaire Chez patients à risques (HTA, coronaropathie, troubles du rythme ou de la conduction, insuffisance rénale) : bolus moins rapide et apport de potassium avec suivi biologique ATCD cardiopathie ou insuffisance rénale : ECG et kaliémie dans les 48 h suivant le bolus NB : on limitera l'effet diabétogène des corticoïdes par un régime contrôlé en hydrate de carbone, au moins chez les patients à risques de diabète[70].…”

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