Hiperglicemia y diabetes inducidas por esteroides / Hyperglycemia and steroid-induced diabetes

La hiperglicemia y/o diabetes inducida por esteroides, se define como la elevación de la glicemia, causada por la acción de los fármacos glucocorticoideos, sobre el metabolismo de los carbohidratos, y presenta una prevalencia entre un 20% al 50%, en pacientes sin diabetes previa, existiendo mayor riesgo para esta patología en pacientes con diabetes pre-existente, obesidad, uso crónico de esteroides o en dosis altas, entre otros. El diagnóstico se rige por los criterios para diabetes en la mayoría de los casos. No obstante, existen casos en donde la hiperglicemia por esteroides es sub-diagnosticada. Su manejo se basa en el tratamiento farmacológico (antidiabéticos orales, subcutáneos e insulina) y no farmacológico (dieta y ejercicio), tomando en cuenta, el patrón glicémico, peso, edad, co-morbilidades, dosis, tipo y tiempo de uso de los esteroides. La relevancia de conocer como diagnosticar y tratar dicha patología, se debe al riesgo de ingreso hospitalario, de infección, de mala cicatrización y de mortalidad en casos no tratados. En vista del aumento del uso de glucocorticoides en la actualidad, se hace una revisión del abordaje terapéutico de la hiperglicemia y diabetes inducida por esteroides.

Hyperglycemia and Steroid-induced Diabetes is defined as the elevation of glycemia caused by the action of glucocorticoid drugs on carbohydrate metabolism, with a prevalence between 20% and 50% in patients without Diabetes. Though, there is a greater risk of this pathology in patients with pre-existing Diabetes, Obesity, chronic use of steroids or in high doses, among others. In most cases, the diagnosis is governed by the criteria of Diabetes; however, there are cases where hyperglycemia Steroid-induced is under-diagnosed. Its management is based on pharmacological treatment (oral and subcutaneous hypoglycemic agents and insulin) and non-pharmacological treatment (diet and exercise), in accordance with the glycemic pattern, weight, age, co-morbidities, dose, type and the duration of the use of steroid. The relevance of knowing how to diagnose and treat this pathology is the risk of hospital admission, infection, poor healing and mortality in untreated cases. In view of the increased use of glucocorticoids nowadays, a review is made about the therapeutic approach to hyperglycemia and steroid-induced Diabetes.

Effect of cognitive-behavioral therapy on fear of hypoglycemia and self-management behavior in patients with steroid diabetes mellitus / 中国实用护理杂志

Objective:To explore the effect of cognitive-behavioral therapy on fear of hypoglycemia and self-management behavior of patients with steroid diabetes mellitus.Methods:A total of 76 patients with steroid diabetes mellitus from August 2018 to October 2019 in the First Affilated Hospital of Nanjing Medical University were selected and divided into experimental group and control group according to the admission time, and each group contained 38 cases. The control group recieved routine therapy and nursing care, on the basis of this, the experimental group was given cognitive-behavioral therapy for 8 weeks. Before and after 8 weeks of intervention, the effects were assessed by Chinese version Hypoglycemia Fear Surgey-Worry Scale(CHFSⅡ-WS) and Sumary of Diabetes Self Care Activities (SDSCA), respectively.Results:There was no significant difference in the score of CHFS Ⅱ-WS, SDSCA before intervention between the two groups( P>0.05). After 8 weeks of intervention, the scores of worry & fear and total CHFS Ⅱ-WS scores were (6.61±1.66), (8.75±1.73) points in the experimental group and (7.60±1.44), (9.69±1.77) points in the control group, the differences were statistically significant ( t values were 2.678, 2.247, P<0.05); in addition, the scores of diet, exercise, blood sugar testing, medications in SDSCA were (20.36±1.91), (11.86±2.27), (7.19±1.56), (6.86±0.99) points in the experimental group, and (18.51±1.50), (9.89±2.29), (5.71±1.45), (5.31±1.18) points in the control group, the differences were statistically significant ( t values were 3.644-5.983, P<0.05). Conclusions:Cognitive-behavioral therapy can effectively alliviate fear of hypoglycemia and promote self-management behavior of steroid diabetes mellitus patients.

Clinical analysis of 38 cases of steroid-induced diabetes mellitus due to glucocorticoid treatment / 中华皮肤科杂志

Objective To investigate risk factors for and clinical features of steroid-induced diabetes mellitus due to glucocorticoid treatment.Methods Clinical data were collected from 798 patients who received systemic glucocorticoid treatment in Department of Dermatology of Hangzhou Third People's Hospital from 2013 to 2016,and analyzed retrospectively.Logistic regression analysis was performed to analyze the factors influencing the occurrence of steroid-induced diabetes mellitus (SDM),repeatedmeasures analysis of variance to compare peripheral blood glucose levels of patients with SDM after breakfast,lunch and dinner,and t test to compare the levels of fasting blood glucose and glycosylated hemoglobin (HbA1 c) between patients with SDM and those with type 2 diabetes mellitus.Results Of the 798 patients,38 developed SDM due to glucocorticoid treatment.The average age was significantly older in the patients with SDM ([66.86 ± 13.30] years,n =38) than in those without SDM ([39.95 ± 17.01] years,n =760;t =8.86,P ＜ 0.01),but there was no significant difference in the gender ratio between the patients with and thhose without SDM (x2 =1.61,P =0.20).The prevalence of fatty liver,hyperlipidemia,hypertension,abnormal liver function and family history of diabetes mellitus was significantly higher in the patients with SDM than in those without SDM (x2 =12.25,19.25,32.69,21.47,16.70 respectively,all P ＜0.01).Logistic regression analysis showed that age,fatty liver,hyperlipidemia,hypertension,abnormal liver function,dosage of glucocorticoids,duration of glucocorticoid therapy,use of immunosuppressive agents and family history of diabetes mellitus were risk factors for SDM (all P ＜ 0.05).There were no significant differences in fasting blood glucose levels or postprandial peripheral blood glucose levels among the SDM patients receiving glucocorticoid therapy at different dosages of 0.50-0.74,0.75-0.99,1.00-1.25 mg·kg-1· d-1 (P ＞ 0.05).The peripheral blood glucose levels after breakfast,lunch and dinner were (11.50 ± 2.90),(16.02 ± 5.81) and (16.81 ± 4.52) mmol/L respectively in the patients with SDM.The levels of fasting blood glucose and glycosylated HbA 1 c were both significantly lower in the patients with SDM than in those with type 2 diabetes mellitus (t =3.74,9.92 respectively,both P ＜ 0.001).Conclusions The risk factors for SDM are age,dosage of glucocorticoids,duration of glucocorticoid therapy,fatty liver,hyperlipidemia,hypertension,abnormal liver function,use of immunosuppressive agents and family history of diabetes mellitus.The patients with SDM showed obviously elevated blood glucose levels mostly after lunch and dinner,but slightly increased levels of fasting blood glucose and glycosylated HbA 1c,which can be used to distinguish between SDM and type 2 diabetes mellitus.