Endocrine Abstracts

Introduction: Diabetogenic effect limits the use of glucocorticoids (GC).

Aim: To evaluate the role of modified HOMA-IR and HOMA-islet indices in different carbohydrate metabolism disorders (CMD) during oral (OGCT) and PULSE (GCPT) glucocorticoid therapy (GCT).

Patients and methods: A study including 165 patients with systemic lupus erythematosus (n=53), systemic vasculitis (n=45) and chronic glomerulonephritis (n=67) was performed. 98 patients received GCPT (course dose – 1800–3000 mg) and 67 – OGCT 15–30 mg/day.

Results: GCPT was associated with less CMD compared to OGCT. Impaired fasting glucose (IFG) was observed in 8 (8.2%) and 14 (20.9%), impaired glucose tolerance (IGT) – in 13 (13.3%) and 21 (31.3%) and diabetes mellitus (DM) – in 12 (12.2%) and 19 (28.4%) patients receiving GCPT and OGCT, respectively. There was a significant decrease of HOMA-islet during glycemic peak in DM patients from 13.96 to 6.17 after GCPT (P<0.05), compared to insignificant changes in other groups. After a course of GCPT HOMA-islet was significantly lower in DM patients compared to patients with no CMD (11.8 vs. 15.4). No rapid decrease of β-cell function was observed in OGCT group, instead there was a compensatory increase. Significant differences were observed in patients receiving OGCT both at baseline and after OGTT on HOMA-IR (4.53 vs. 9.81 in patients with IGT; 5.6 vs. 11.27 in patients with DM); no differences were observed in patients without CMD (2.59 vs. 2.88) and with IFG (2.88 vs. 5.85). A significant decrease of β-cell function was observed in DM patients, reflected by a decrease of HOMA-islet after OGTT compared to baseline (147 vs. 78.4).

Conclusion: The evaluation of modified HOMA-IR and HOMA-islet indices before the start of intensive GC treatment and during OGCT may improve early detection of risk groups for serious CMDs – IGT and DM.