Review ArticleGlucocorticoid-Induced Hyperglycemia
Section snippets
INTRODUCTION
We performed a review of the available literature on glucocorticoids (GCs) and their effect on plasma glucose concentrations. Relevant articles were determined from a literature search of MEDLINE and Google with use of the following keywords: glucocorticoids, prednisone, dexamethasone, hyperglycemia, diabetes mellitus, pharmacokinetics, pharmacodynamics, and treatment. Articles that predated electronic searches were discovered through a library reference search. The dates of the search were
TREATMENT OF GC-INDUCED HYPERGLYCEMIA
We recognize that any argument for the treatment of hyperglycemia caused by the introduction of medications intended for short-term (< 1 month) use is debatable. Fluctuations in plasma glucose concentrations, however, have been associated with increased cardiovascular mortality (25). A mechanism for this relationship is suggested by studies showing that even short-term or postprandial hyperglycemia is associated with acute inflammation and endothelial dysfunction in patients without diabetes and
CONClUSION
For the treatment of numerous conditions, GCs are used often. They offer clear clinical benefit, and in many cases, few therapeutic alternatives are available. Nevertheless, they also lead to a predictable increase in insulin resistance in all patients and hyperglycemia in many of them. The combination of anticipation of GC-induced hyperglycemia and use of insulin to prevent it is the best current management option available, yet its use is not widespread. We have described a proactive strategy
DISClOSURE
The authors have no conflicts of interest to disclose.
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Published as a Rapid Electronic Article in Press at http://www.endocrinepractice.org on May 6, 2009. DOI: 10.4158/EP08331.RAR