Assessment of the Prevalence and Risk Factors Associated With Glucocorticoid-Induced Diabetes Mellitus in Pemphigus Vulgaris Patients
-
Abbas Darjani
,
Nahid Nickhah
,
Mohammad Hassan Hedayati Emami
,
Narges Alizadeh
,
Rana Rafiei
,
Hojat Eftekhari
,
Kaveh Gharaei Nejad
Abstract
Pemphigus vulgaris is a chronic autoimmune disease and glucocorticoids are one of the main treatments. Our study investigates the prevalence and associated factors of glucocorticoid-induced diabetes mellitus in these patients under different glucocorticoid regimens. 36 patients with first diagnosed Pemphigus vulgaris based on pathological and direct immunofluorescence findings who had received different glucocorticoid regimens (1-2 mg/kg oral or 1-2 mg/kg oral with 1g methylprednisolone pulse daily for 3 consecutive days with or without azathioprine) were evaluated during 2014-2016. Our study found that 22.2% of patients had impaired fasting glucose and incidence of corticosteroid-induced diabetes mellitus was 22.2% with no difference between oral and pulse therapy of corticosteroid. The first day after pulse therapy 19 patients of 21 had post bolus hyperglycemia that 36% of them became diabetic after 8 weeks. None of the variables, including age, BMI, HbA1c, LDL, HDL, TG, cholesterol, family history and blood pressure were associated with diabetes. Pretreatment FBS was the factor that would increase the likelihood of glucocorticoid-induced diabetes mellitus, 42.2% of patients with pretreatment FBS 100-126 developed diabetes in comparison with 17.2% in normal pretreatment FBS. Although the group who received azathioprine was associated with increased incidence of diabetes, the overall corticosteroid dose in this group was significantly higher than the other group (P=0.012), and controversy with other studies could be because of difference in corticosteroid dosage and small number of patients. The incidence of diabetes was not different between the group with glucocorticoid pulses and oral prednisolone without pulse therapy. Higher pretreatment FBS can be related to increased incidence of diabetes, but results from this study due to small number of patients are preliminary and multicenter studies are needed.
. Wojnarowska F, Venning VA, Burge SM, Immunobullous disease in: Burns T, Breathnach S, Cox N, Griffiths C. Rook’s Textbook of dermatology. Black well publishing, 2004; 41:41.3-41, 12.
Irwin MF, Arthur ZE, Kalus W, Frank A, Lowll AG, Stephen LK, Fitz patrick’s dermatology in general medicine. 6th Edition. New York: MC Graw-holl, 2004; 59:558-567.
Rucocco E, Baroni A, Wolf R, Ruocco V,Life-threatening bullous dermatoses: Pemphigus vulgaris. Clin Dermatol, 2005; 23:223-26.
Zeina B, MD, PhD Consulting Staff, Department of Dermatology, Milton Keynes Hospital, UK , http://emedicine.medscape.com/article/1064187-overview#aw2aab6b2b4aa, 2014.
CeCilia lansang M, Hustak LK, Glucocorticoid-induced diabetes and adrenal suppression: how to detect and manage them. Cleveland clinic journal of medicine. 2011; 78(11):748-56. doi: 10.3949/ccjm.78a.10180.
Ha YJ, Lee KH, Jung SJ and et al, Glucocorticoid-induced diabetes mellitus in patients with systemic lupus erythematous treated with high-dose glucocorticoid therapy. Lupus, 2011, 20:1027–34.
Kim SY, Yoo CG, Lee CT, Chung HS and et al. Incidence and risk factors of steroid-induced diabetes in patients with respiratory disease. J Korean Med Sci, 2011; 26:264–7.
Pagano G, Cavallo Perin P, Cassader M and et al., An in vivo and in vitro study of the mechanism of prednisone-induced insulin resistance in healthy subjects, Journal of Clinical Investigation, 1983; 72(5), 1814–1820.
Abdelmannan D, Tahboub R, Genuth S and et al., Effect of dexamethasone on oral glucose tolerance in normal individuals, Endocrine Practice, 2010; 16(5), 770–777.
Nicod N, Giusti V, Besse C, and Tappy L, Metabolic adaptations to dexamethasone-induced insulin resistance in healthy volunteers.” Obesity Research, , 2003; 11(5), 625-631.
Bolognia JL, Jorizzo JL, and Schaffer JV, Bolognia’s Dermatology 3rd Edition
Valikhani M, Khoshniat Niko M, Tork AN, Risk factors and frequency of steroid - induced diabetes in pemphigus vulgaris patients during 1 year study, Iranian journal of diabetes and lipid disorders, 2007; 6(3) : 301-307.
Gonzalez-Gonzalez J G, Mireles-Zavala LG, Rodriguez-Gutierrez R, Gomez-Almaguer D, Lavalle-Gonzalez F J,. Tamez-Perez H E, Gonzalez-Saldivar G and Villarreal-Perez J Z, Hyperglycemia related to high-dose glucocorticoid use in noncritically ill patients, Gonzalez-Gonzalez et al. Diabetology & Metabolic Syndrome 2013, 5:18.
Alavi A, Lowe J, Walsh S, Juurlink D, Mortaz-Hedjri S and Neil H, Corticosteroid-induced hyperglycemia is increased 10-fold in patients with pemphigus. International Journal of Dermatology 2012; 51, 1248–1252.
Perez HET, De-Ossio MDG, Flores DLQ, Coria MIH, Peña ALT, Pérez GJC, SLP Peña, Glucose disturbances in non-diabetic patients receiving acute treatment with methylprednisolone pulses, Revista da Associação Médica Brasileira (English Edition) 58(1), 2012; 125–128.
R Calafiiore, G Basta, A falorni, M Pietropaolo, Picchio ML, Calcinaro F, Brunetti P, Preventive effects of azathioprine on the onset of diabetes mellitus in NOD mice, Journal of Endocrinological Investigation, 1993; 16(11), 869-873.
Silverstein J, Maclaren N, Riley W, Spillar R, Immunosuppression with Azathioprine and Prednisolone in Recent-Onset Insulin Dependent Diabetes Mellitus. N Engl J Med 1988; 319:599-604.
Zabihi YM, Sadeghi S, Risk Factors of Glucocorticoid-Induced Diabetes Mellitus in Systemic Lupus Erythematosus, Galen Medical Journal, 2013; 2:2.
Esmaeili N, Soori T, Shirzad N, Vahid-Moghadam M, Karimi A, Frequency and risk factors for steroid-induced diabetes in pemphigus vulgaris patients in Razi Hospital, Tehran. Dermatology and Cosmetic 2015; 6(3): 140-146.
| Files | ||
| Issue | Vol 55, No 6 (2017) | |
| Section | Original Article(s) | |
| Keywords | ||
| Glucocorticoid Diabetes mellitus Pemphigus vulgaris | ||
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