Endocrine Abstracts

Introduction: Long-term use of glucocorticoids has impact on reduction of β-cell function and peripheral insulin sensitivity, leading to a steroid diabetes.

Aim: To assess patterns of change of glycaemia and need for insulin at admission to hospital, during days 1–5 and at discharge in patients with newly diagnosed type 2 diabetes (NST) compared with patients with a history of taking corticosteroids and newly diagnosed diabetes mellitus (ST).

Material and methods: Twenty patients with newly diagnosed diabetes were included; ten without, and ten with a history of taking corticosteroids. The day after admission (day 1) basal-bolus insulin scheme was introduced. Bolus insulin was used in the initial dose of 0.05 U/kg per meal, and a basal insulin (NPH) 0.2 IU/kg BW at bedtime. The changes of glycaemia during 1–5 days were observed by measurement of plasma glucose profile before meals and 2 h after/before bedtime, and the need for insulin during the investigated time was recorded. A statistical analysis of data was performed.

Results: 12 women (six NST and six ST) and eight men (four NST and four ST) were included in the study. The longest period of taking corticosteroids was 150 days, with a cumulative dose of 9600 mg of methylprednisolone. Statistically significant differences (P<0.05) were obtained: in total dose bolus insulin and the number of units per kilogram BW before dinner between NST and ST groups, and in the ST group in the first 5 days of treatment vs. at discharge; changes in plasma glucose in the period after lunch to dinner in ST group. There was a positive correlation between the cumulative dose of corticosteroids and the plasma glucose at admission at women in ST group.

Conclusion: Corticosteroids primarily cause hyperglycaemia in the afternoon and evening, and the targeted treatment and monitoring of glycaemic control should be directed to the above hours.