1. Development of Steroid induced dysglycemia during the 48 hours of steroid therapy in hospitalized patients; its correlation with the type of steroid used and the presence of risk factors for diabetes.
DR. SHIKHA SHARMA, DR APARNA AGRAWAL Department Of General Medicine LHMC & SSK Hospital New Delhi

2. INTRODUCTION Glucocorticoid use leads to hyperglycemia. 1 Mechanism
>Decreases insulin synthesis
>Increases insulin resistance2
>Glucose uptake and glucose storage in muscles, stored as glycogen3,4
>Increased lipolysis and proteolysis5
>Permissive effects upon hormones like catecholamines and glucagon

3. DEFINITION AND INCIDENCE
FBG level of ≥ 126 mg/dL, glycaemia at any time ≥ 200 mg/dL, glycated hemoglobin ≥ 6.5% or blood glucose ≥ 200 mg/dL two hours after an oral glucose load with classic signs and symptoms of hyperglycemia.6
Incidence of steroid induced hyperglycemia= 34-68%7,8
Incidence of steroid induced diabetes mellitus=1.6-64%8,9

4. AIMS AND OBJECTIVES
To study the changes in blood glucose levels between 6-48 hours of starting corticosteroid therapy.
To study the various factors associated with steroid induced hyperglycemia with special reference to the :-
-Nature of the corticosteroid used.
-Presence of risk factors for diabetes.

5. INCLUSION CRITERION
Age≥ 18years to be started on oral or parenteral steroid therapy irrespective of their underlying disease and comorbid illness.

6. EXCLUSION CRITERION Pregnant or lactating woman. Known diabetic
RBG≥200 mg/dl prior to steroid therapy.
Presteroid RBG mg/dl with Hba1c ≥6.5%
Patients on oral/parenteral steroid in the last 4 weeks.
Patients on dextrose containing iv drips
Non consenting patients.
Note-Patient already on inhaled and/or topical corticosteroids will not be excluded from the study

7. METHODOLOGY
Hundred in-patients to be started on oral/parenteral steroids.
Evaluation of risk factor for diabetes
> Age
> BMI {overweight = kg/m2, obese ≥30kg/m2}
> Waist circumference{Men=90cm, Women=80cm}
> Hypertension{BP ≥140/90 mmHg}
> Dyslipidemia.{Total cholesterol ≥200mg/dl or
Triglycerides ≥150mg/dl}

8. METHODOLOGY EXCLUDED STUDY POPULATION
Patients to be started on steroid therapy
Not a known diabetic
Known diabetics
Meeting other exclusion criterias
RBG
<140mg/dl
EXCLUDED
≥200mg/dl
Hba1c
STUDY POPULATION
≥6.5%
<6.5%

9. STUDY POPULATION Start steroids RBS at 6,12,24 and 48 hours
Consent
Start steroids
RBS at 6,12,24 and 48 hours
Lipid profile

10. OBSERVATIONS AND RESULTS
DEMOGRAPHY

11. DYSGLYCEMIA

12. p=0.001

13. ≥60 mg/dl rise in blood glucose value after 48 hours of steroid therapy with regard to steroid used
hydrocortisone
(N=54)
dexamethasone
(N=32)
prednisolone
(N=14)
Number of patients
19(35.18%)
3(9%)

14. RISK FACTORS
TOTAL(N)
N=100
DYSGLYCEMIA
N=70
IGT
N=48
SDM
N=22
P value
Age≥50years 43
41(95.3%)
24(55.8%)
17(39.5%)
0.001
BMI≥23kg/m2 20
20(100%)
14(70%)
6(30%)
0.005
HTN 14
14(100%)
8(57.1%)
6(42.9%)
0.015
WC≥90cm (in males)
≥80cm (in females) 25
25(100%)
15(60%)
10(40%)
Dyslipidemia 33
28(84.8%)
14(42.4%)

15. Number of risk factors and dysglycemia
No of risk factors
Normoglycemia(%)
Dysglycemia(%)
SDM(%) 75 25 1
18.5
81.5
11.1 2 4 96 44 3
100
83.3
33.3 5
p=0.001

16. CONCLUSION
Steroid induced dysglycemia was observed in 70% of the patients within 48 hours of therapy.
Patients receiving parenteral hydrocortisone are more likely to develop dysglycemia which is also more severe compared to parenteral dexamethasone and oral prednisolone.
Older age, presence of hypertension, dyslipidemia and presence of central or generalised obesity increases the risk of development of steroid induced hyperglycemia. The risk further increases with increasing number of risk factors.
Thus, it becomes imperative to monitor blood sugar for patients starting on steroid therapy.

17. REFERNCES
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