THE CLINICAL AND THERAPEUTIC ASPECTS OF STEROID-INDUCED DIABETES

Background and Aims: Glucocorticoid-induced diabetes mellitus (GC-DM)is an underdiagnosed condition that sometimes requires urgent treatment. Indeed, the risk factors of GC-DM as well as its therapeutic management are little known. The aim of this study was to review the characteristics of the population at risk for developing GC-DM as well as its therapeutic modalities. Methods: A retrospective descriptive study was conducted at Charles Nicolle Hospital in Tunis enrolling 52 patients with GC-DM who were followed up in the Department of Endocrinology and Internal Medicine (1992-2020). Results: Mean age of patients was 47,8 ± 15,3 years. Eighteen patients (35%) had a family history of diabetes. The median body mass index (BMI) was 25.35 kg/m² [22.04-29.95]. Overweight was found in 25% and obesity in 25%. Twenty-two patients (42%) had hypertension, 21 (40%) had dyslipidaemias and 10 (19%) had IFG. The main underlying diseases requiring steroid therapy included vasculitis in 24 patients (46%) and autoimmune diseases in 15 patients (29%). In 54% of the patients, steroid therapy was administered at a high dose, in 35% at a very high dose, and in 11% at a medium dose. The median fasting blood glucose level at the time of diagnosis of GC-DM was at 14 mmol/L [9-18]. Fifteen patients (29%) developed GC-DM after 1 year. A pharmacological treatment was combined with lifestyle and dietary measures in 50 patients (96%). Oral antidiabetic agents alone were prescribed in 50% of the patients, insulin therapy: alone in 40% and in combination with oral antidiabetic agents in 6%. Methylprednisolone pulse therapy was significantly associated with initiation of insulin. Conclusion: Diabetes should not be neglected during steroid therapy. Strategies for prevention, detection and therapeutic management of GC-DM are the key elements to control the Morbi-mortality related to this condition.