Glucocorticoids and Type 2 Diabetes: From Physiology to Pathology

Steroid diabetes

glucocorticoid induced diabetes mellitus

Indeed, high-dose glucocorticoid treatment impaired insulin-mediated suppression of endogenous glucose production, insulin-stimulated glucose disposal and insulin-induced suppression of adipose tissue lipolysis [2] [9]. This page was last edited on 30 January , at In vitro studies have been shown that glucocorticoids may reduce glucose uptake and oxidation and upregulate potassium-gated ion channels with impaired depolarization and decreased calcium influx a stimulus for insulin granule release [ 58 — 60 ].

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Eur J Endocrinol Biol Blood Marrow Transplant 17 2: Measurement of glycated haemoglobin has been suggested for the diagnosis of diabetes in the general population and may be even more helpful in the clinical setting of EH because this parameter is an integrated measure of glucose homeostasis [ 47 ]. View at Google Scholar I. Recent developments of novel glucocorticoid compounds that possess immunosuppressive properties devoid of dysmetabolic actions has revived research into the scope and mechanisms of steroid diabetes. The latter mechanism may additionally exacerbate glucose intolerance since elevated levels of fatty acids may further impair skeletal muscle and liver insulin sensitivity. Home News About Get involved Log in.

Generally, steroid diabetes without preexisting type 2 diabetes will resolve upon termination of corticosteroid administration. Steroid diabetes does not occur with other steroid hormones , such as anabolic steroids or sex steroids because these other categories of steroids have actually shown to have positive effects on glucose metabolism. From Wikipedia, the free encyclopedia. This article includes a list of references , but its sources remain unclear because it has insufficient inline citations.

Please help to improve this article by introducing more precise citations. February Learn how and when to remove this template message. Retrieved from " https: Articles lacking in-text citations from February All articles lacking in-text citations. Mood, memory, and mechanisms. Ann N Y Acad Sci Ann Rheum Dis 71 7: J Clin Invest Nat Rev Mol Cell Biol 12 Trends Endocrinol Metab 22 A complication of steroid and immunosupressive therapy.

Diabetes Care 6 1: Transplant Proc 32 8: Transplant Proc 31 1—2: Nephrol Dial Transplant 22 7: Clin Transplant 21 1: Diabetes Care 30 3: Arthritis Rheum 64 3: Scand J Urol Nephrol Suppl.

Nephron Clin Pract 2: The effects of glucocorticoid excess on hepatic gluconeogenesis have been also shown during fasting, as suggested by in vitro studies demonstrating a dexamethasone-induced activation of key enzymes involved in gluconeogenesis, such as phosphoenolpyruvate carboxykinase [ 38 ].

This effect may involve other proteins, such as liver X receptors, providing evidence for crosstalk between different metabolic pathways, such as glucose and cholesterol pathways, which could be affected by glucocorticoid excess [ 39 ].

Glucocorticoids exert their negative effects on insulin sensitivity also by modifying lipid and protein metabolism: Insulin resistance is also favoured by the abnormal distribution of body fat mass occurring in patients with CS, characterized by a specific increase of visceral adipose tissue.

Finally, glucocorticoids may modulate the expression and the activity of adipokines, such as adiponectin, leptin, and apelin, which in turn may impair insulin sensitivity [ 41 ]. About half of CS patients have been shown to have alterations of glucose metabolism, and two thirds of these cases had diabetes, regardless of gender [ 42 ].

Diabetes occurs independently of the aetiology of glucocorticoid excess and does not seem to be correlated to disease duration. However, the available data do not support the screening for CS in diabetes clinics because of the high cost-effectiveness and the lack of specific tests for diagnosing CS, especially in patients with slightly elevated cortisol secretion and subclinical hypercortisolism [ 44 ].

Special consideration should be given to subclinical cortisol secretion in adrenal incidentalomas see specific paragraph below. In patients with EH the measurement of fasting glucose may underestimate the real prevalence of glucose disorders, as suggested by the observation that more than one half of patients with EH and diabetes were shown to have normal fasting glucose [ 27 ].

This seems to be true also for patients taking exogenous glucocorticoids, in whom high glycemic values were shown to occur in the afternoon and in the evening [ 45 ]. The oral glucose tolerance test OGTT is therefore considered the diagnostic gold standard for identifying the impairment of glucose metabolism in EH [ 46 ], and for monitoring changes in glucose homeostasis.

Measurement of glycated haemoglobin has been suggested for the diagnosis of diabetes in the general population and may be even more helpful in the clinical setting of EH because this parameter is an integrated measure of glucose homeostasis [ 47 ]. Moreover, a high variability has been demonstrated in different ethnic groups in the sensitivity and specificity of glycated haemoglobin assays. Surrogate markers of peripheral insulin activity, such as homeostasis model assessment and whole-body insulin sensitivity indexes, could also be useful for the early identification of patients with insulin resistance before the development of overt diabetes [ 48 ].

To date, the most frequent cause of hypercortisolism is the chronic therapy with glucocorticoids mainly prescribed for their anti-inflammatory effects through multiple pathways that promote the synthesis of anti-inflammatory proteins [ 49 ]. In addition to formulations intended to have systemic effects, topic formulations are widely used for specific clinical conditions and could also have systemic effects: In glucocorticoid-treated patients, the odds ratio for development of new-onset diabetes mellitus has been reported to be from 1.

Hyperglycaemia is a potential concern with both short-term 4 weeks or less and long-term glucocorticoid treatments, such as in transplant recipients to prevent rejection or to treat graft-versus-host disease. However, there are no clear guidelines on the monitoring of blood glucose levels in patients undergoing long-term glucocorticoid treatment, and on the management of glucocorticoid-related diabetes, except for patients undergoing transplants: The transplant guidelines do mention that an oral glucose tolerance test may be more sensitive, but this is often cumbersome to perform.

Checking random postprandial plasma glucose levels could be helpful in this regard. The American Diabetes Association cutoff for diagnosing diabetes when using a random i. Glucocorticoid-induced diabetes is similar to type 2 diabetes because glucocorticoids impair glucose metabolism mainly through increasing insulin resistance, which occurs in the liver with increased basal glucose production, and in the adipose and skeletal tissues with impaired glucose utilization: These findings were supported by subsequent studies [ 56 , 57 ].

Exogenous glucocorticoids could also interfere with the signalling pathways of various insulin secretagogues, but the exact mechanisms are still unknown. In vitro studies have been shown that glucocorticoids may reduce glucose uptake and oxidation and upregulate potassium-gated ion channels with impaired depolarization and decreased calcium influx a stimulus for insulin granule release [ 58 — 60 ].

The metabolic syndrome MetS is a cluster of abnormalities that include central obesity, impaired glucose tolerance, hypertension, and dyslipidaemia [ 62 — 65 ]. Insulin resistance is one of the main defects which is shared between the individual components of the MetS although the strength of this correlation varies between, and even within, different populations [ 66 ]. Many studies have been shown a strong association between obesity, glucose intolerance, and diabetes: However, the risk of developing diabetes has been shown to be higher in females: Both insulin levels and BMI have been shown to be independent predictors of cardiovascular disease [ 70 ].

Similar results have been found in a study performed in male health professionals: The relationship between weight gain and diabetes appears to be relatively consistent among different ethnicities [ 73 — 75 ]. Glucocorticoids exert their effects also in the adipose tissue influencing its activity: Therefore, there is evidence that cortisol could play a role in determining the adiposity in MetS, even if there are conflicting results in the literature. Furthermore, some studies showed a positive correlation between cortisol and waist circumference [ 81 — 83 ], whilst other authors reported no relationship between these two parameters [ 83 , 84 ].

Iamges: glucocorticoid induced diabetes mellitus

glucocorticoid induced diabetes mellitus

Exogenous glucocorticoids could also interfere with the signalling pathways of various insulin secretagogues, but the exact mechanisms are still unknown. It was also recently reported that short-term exposure to glucocorticoids reduced the insulinotropic effects of GLP-1 [ 36 ]. In vitro studies have been shown that glucocorticoids may reduce glucose uptake and oxidation and upregulate potassium-gated ion channels with impaired depolarization and decreased calcium influx a stimulus for insulin granule release [ 58 — 60 ].

glucocorticoid induced diabetes mellitus

Patients with an older age, higher HbA1c level and lower eGFR require close monitoring for the development of GC-DM, regardless of the dose of glucocorticoids being administered.

glucocorticoid induced diabetes mellitus

Arthritis Rheum glucocorticoid induced diabetes mellitus 3: Mild hyperglycemia in an immunocompetent patient may not require treatment if the steroids will be discontinued in a week or two. Thus, official treatment guidelines are lacking. In this study we also showed an independent relationship between T2D and the SCS secreting pattern with an independent cheap hgh up of age, which was higher in the SCS patients with respect to the nonsecreting patients. Metabolic adverse effects of glucocorficoid glucocorticoid dosages It is important to note that glucocorticoid induced diabetes mellitus studies investigating the effects of knduced have used high dosages.