Background The duration and doses of glucocorticoids (GC) are significant prognostic factors of glucose intolerance and diabetes in rheumatologic diseases
Objectives To evaluate the influence of GC pulse-therapy (PT) on carbohydrate metabolism in patients with rheumatologic diseases.
Methods The study included 27 patients (men – 4, women - 23) with different rheumatologic diseases (lupus erythematosus – 20, systemic vasculitis - 7) aged 18-68 years (mean age 42,3±14,43) and duration of disease from six months to 12 years (mean 3,55±3,36). GC PT consisted of intravenous infusion of 600-1000 mg of prednisone a day for 3 consecutive days (total dose for a course 1800-3000 mg/day). We performed the evaluation of glucose levels in all patients before the start of PT and at 2, 4, 6,10, 24, 48 and 72 hours after the infusion, and in patients with abnormal blood glucose level at 72 hours after the infusion the evaluation was continued until normalization of blood glucose levels.
After the course of PT all patients performed an oral glucose tolerance test (OGTT). Patients with normal OGTT were included in the first group (blood glucose less than 7,8 mmol/l 2 hours after oral administration of 75 g of glucose). Twenty patients aged 18-54 (mean age 38,0±2,8) years were included in the first group. Patients in the second group had blood glucose levels above 7,8 mmol/l after the OGTT. This group consisted of 7 patients aged 44- 61 years (mean age 52,5±8,5).
Results All patients included in the study demonstrated an increase of blood glucose levels after the course of PT, reaching maximum 4 hours after the start of the infusion – in the first group levels reaching 11,2±0,92 mmol/l, in the second group 21,95±0,25 mmol/l (p<0,05). Blood glucose normalization in the first group was observed during 1,75±0,18 days (1 to 3 days), whereas in the second group during 4,0±1,0 (3 to 5 days) (p<0,05). During OGTT mean fasting blood glucose level in the first group was 4,59±0,11 mmol/l, in the second group – 5,95±0,45 (p<0,05); 2 hours after the glucose load – 6,0±0,21 mmol/l and 10,0±1,5 mmol/l respectively (p<0,05).
Conclusions GC PT in rheumatologic patients is associated with abnormal blood glucose levels, indicating the presence of glucose intolerance. High blood glucose during PT and long period until normalization of blood glucose levels are prognostic factors of carbohydrate metabolism disturbances.
Disclosure of Interest None declared