J Endocrinol Metab
Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access
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Editorial

Volume 8, Number 2-3, May 2018, pages 15-15


The Efficacious and Safe Treatment for Steroid-Induced Hyperglycemia

Hidekatsu Yanai

Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, 1-7-1 Kohnodai, Ichikawa, Chiba 272-8516, Japan

Manuscript submitted February 19, 2018Manuscript submitted February 28, 2018Short title: Editorial
doi: https://doi.org/10.14740/jem492w

In Vol. 8, No. 1, 2018, p10-12, Hamasaki and Morimitsu report an efficacious and safe application of glucagon-like peptide-1 (GLP-1) analogue to steroid-induced hyperglycemia in an old type 2 diabetic patient with renal insufficiency [1]. Glucocorticoid-induced insulin resistance and pancreatic islet-cell dysfunction lead to mild increase in fasting plasma glucose levels and a greater increase in postprandial glucose levels [2-7]. The underlying mechanisms for glucocorticoid-induced hyperglycemia include increased hepatic endogenous glucose production, reduced insulin-stimulated glucose uptake in skeletal muscle, and increased visceral fat deposition and insulin resistance [2, 3, 8]. Moreover, glucocorticoids may impair insulin secretion from β cells and may augment glucagon secretion from α cells [2, 4, 5]. Although there are no guidelines for the treatment of hyperglycemia in patients taking glucocorticoids, short-acting prandial insulin therapy is currently recommended [9]. However, insulin therapy increases the risk of adverse effects, such as hypoglycemia and weight gain. Furthermore, it is too difficult to determine the optimal insulin dose, because the doses and efficacy of glucocorticoids are frequently changed due to the severity of the diseases treated by glucocorticoids.

We previously reported the effectiveness and safety of sitagliptin, one of the dipeptidyl peptidase-4 (DPP-4) inhibitors, for the treatment of hyperglycemia in patients taking glucocorticoids [10, 11]. Jensen et al reported that glucocorticoid-induced glucose intolerance is associated with a progressive decline of incretin effects [12], suggesting the incretin-based therapy including the DPP-4 inhibitors and GLP-1 analogues may be useful for the treatment of glucocorticoid-induced hyperglycemia.

Conflict of Interest

The author declares that he has no conflict of interest concerning this article.


References▴Top 
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  2. van Raalte DH, Diamant M. Steroid diabetes: from mechanism to treatment? Neth J Med. 2014;72(2):62-72.
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  7. Burt MG, Roberts GW, Aguilar-Loza NR, Frith P, Stranks SN. Continuous monitoring of circadian glycemic patterns in patients receiving prednisolone for COPD. J Clin Endocrinol Metab. 2011;96(6):1789-1796.
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  8. Rizza RA, Mandarino LJ, Gerich JE. Cortisol-induced insulin resistance in man: impaired suppression of glucose production and stimulation of glucose utilization due to a postreceptor detect of insulin action. J Clin Endocrinol Metab. 1982;54(1):131-138.
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  9. Clore JN, Thurby-Hay L. Glucocorticoid-induced hyperglycemia. Endocr Pract. 2009;15(5):469-474.
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  10. Katsuyama H, Sako A, Adachi H, Hamasaki H, Yanai H. Effects of 6-month sitagliptin treatment on metabolic parameters in diabetic patients taking oral glucocorticoids: a retrospective cohort study. J Clin Med Res. 2015;7(6):479-484.
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  11. Yanai H, Masui Y, Yoshikawa R, Kunimatsu J, Kaneko H. Dipeptidyl peptidase-4 inhibitor for steroid-induced diabetes. World J Diabetes. 2010;1(3):99-100.
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  12. Jensen DH, Aaboe K, Henriksen JE, Volund A, Holst JJ, Madsbad S, Krarup T. Steroid-induced insulin resistance and impaired glucose tolerance are both associated with a progressive decline of incretin effect in first-degree relatives of patients with type 2 diabetes. Diabetologia. 2012;55(5):1406-1416.
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Journal of Endocrinology and Metabolism, bimonthly, ISSN 1923-2861 (print), 1923-287X (online), published by Elmer Press Inc.     
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