Steroid-induced diabetes mellitus and related risk factors in patients with neurologic diseases

Study Objective. To determine the frequency of steroid-induced diabetes mellitus (SDM) and the related risk factors in patients with neurologic diseases who receive high doses of steroids. Design. Retrospective chart review. Setting. Neurology ward of a university-affiliated hospital. Patients. Twenty-five patients with neurologic diseases who received prednisolone 30-60 mg/day orally after breakfast for more than 2 weeks. Measurements and Main Results. Plasma glucose concentrations were determined immediately before and 2 hours after each meal. Steroid-induced diabetes mellitus was diagnosed if the patient had either a fasting glucose concentration of 126 mg/dl or greater, or a random glucose concentration of 200 mg/dl or greater. The patients were divided into two groups on the basis of whether SDM had developed (13 patients) or not (12 patients). Ages, body mass indexes, cumulative total doses and daily doses of prednisolone, duration of therapy, and serum cholesterol and triglyceride concentrations were compared between the groups. Thirteen of the 25 patients were identified with SDM, and all of them had plasma glucose concentrations of 200 mg/dl or greater 2 hours after lunch. Mean age (59.1 +/- 10.2 yrs) and cholesterol concentration after prednisolone treatment (226.8 +/- 36.4 mg/dl) in the SDM group were significantly higher than those values in the non-SDM group (41.3 +/- 18.0 yrs and 188.1 +/- 27.2 mg/dl, respectively, p < 0.01). Conclusions. A close relationship among postprandial hyperglycemia, advanced age, and hypercholesterolemia is a characteristic of SDM in patients with neurologic diseases. Therefore, monitoring the plasma glucose concentration 2 hours after lunch may be useful to detect SDM in these patients.