Endocrine Abstracts

Introduction: One of the most common side effects of glucocorticoid treatment is glucose intolerance and diabetes. Although glucocorticoids cause mainly postprandial hyperglycaemia the International Diabetes Federation, American Diabetes Association and The European League Against Rheumatism recommend to screen patients chronically treated with glucocorticoids by regularly determining fasting plasma glucose. Such an approach can lead to false negative results. Since pre-diabetes and diabetes lead to life-threatening conditions such as chronic renal failure and myocardial infarction it is important to correctly diagnose these conditions.

Objectives: The aim of the study was to evaluate if oral glucose tolerance test (OGTT) is a better screening tool than plasma fasting glucose levels in diagnostics of diabetes in patients chronically treated with glucocorticoids without previously diagnosed pre-diabetes or diabetes. The second objective was to determine the risk factors of developing steroid-induced glucose metabolism impairment.

Material and methods: In 50 patients on GCS treatment diagnosed with connective tissue diseases OGTT was performed. All participants underwent clinical and biochemical evaluation (age, sex, time of treatment, current and cumulative dose and type of steroid, family history of diabetes, BMI, WHR, HbA1c, HOMA-IR).

Results: 13 patients (28%) had impaired glucose tolerance (three of them had coincide impaired fasting glucose). One patient (2%) diagnosed with diabetes had normal levels of plasma fasting glucose. 36 patients had normal glucose metabolism. Apart from age the statistical analysis showed no significant difference between groups in the rest of analyzed parameters thus the prediction of risk factors was impossible.

Conclusions: Only by performing OGTT 22% of patients could be correctly diagnosed with pre-diabetes and diabetes. The oral glucose tolerance test is the only standardized tool that is able to effectively detect the steroid-induced impairment in glucose metabolism. It should be performed in every patients chronically treated with GCS even without other risk factors of diabetes.