Steroid‐induced diabetes: a clinical and molecular approach to understanding and treatment

Abstract

Summary Since the advent of glucocorticoid therapy for autoimmune disease in the 1940s, their widespread application has led to the concurrent therapy-limiting discovery of many adverse metabolic side effects. Unanticipated hyperglycemia associated with the initiation of glucocorticoids often leads to preventable hospital admissions, prolonged hospital stays, increased risks for infection and reduced graft function in solid organ transplant recipients. Challenges in managing steroid-induced diabetes stem from wide fluctuations in post-prandial hyperglycemia and the lack of clearly defined treatment protocols. The mainstay of treatment is insulin therapy coincident with meals. This article aims to review the pathogenesis, risk factors, diagnosis and treatment principles unique to steroid-induced diabetes.

Prevalence and associated factors of steroid induced impaired glucose metabolism in obstructive lung diseases, Jimma, and Southwest Ethiopia, Africa

“…Many studies worldwide like Kim SY et al of Korea done in 2011 and Hwang JL et al of USA done in 2014 showed that patients with respiratory problems like chronic obstructive lung diseases on steroids the glucose metabolism mainly affected by the dose and total duration of steroids but there is no agreement between this study and other studies regarding the effect of steroid dose and duration on glucose metabolism. 16,36,37 This inconsistency can be explained by small sample size as compared with other studies.…”

Role of Steroids in Refractory Hypoglycemia Due to An Overdose of 10,000 Units of Insulin Glargine: A Case Report and Literature Review

“…The mechanism of hyperglycemia is predominantly decreased insulin sensitivity in target tissues leading to insulin resistance. In the liver it results in increased basal glucose production, and in the periphery, especially the adipose and skeletal tissues, glucose use is impaired (18). Glucocorticoids decrease insulin-mediated glucose uptake by inhibiting glucose transporter type 4.…”

“…Glucocorticoids decrease insulin-mediated glucose uptake by inhibiting glucose transporter type 4. Additionally they increase fatty acid release into the blood from the liver which further interferes with glucose utilization, especially by skeletal muscles (18)(19)(20). They can also cause beta cell dysfunction in the pancreas leading to an inability to release insulin.…”

Psychological Stress and Diabetes Mellitus As Complicating Factors in Management of Pemphigus Vulgaris

“…7 Corticosteroid induced DM by increasing blood glucose level to abnormal numbers in patients with or without previous history of DM. 19 Corticosteroids cause hyperglycemia by stimulating proteolysis, increasing enzymes that stimulate gluconeogenesis, and inhibiting glucose intake in muscle and fat tissues. Synthetic corticosteroids like prednisone and dexamethasone are more potent to decrease carbohydrate tolerance compared to natural corticosteroids like hydrocortisone.…”