OBJECTIVE: To identify the incidence and risk factors for corticosteroid-induced hyperglycemia requiring medical therapy among patients with inflammatory eye diseases. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with ocular inflammation followed at 5 United States tertiary centers that initially were neither diabetic nor taking hypoglycemic medications. METHODS: Eligible patients who used oral corticosteroids during follow-up were identified and followed longitudinally for initiation of hypoglycemic medication over 1 year after beginning corticosteroids. The remaining eligible patients were followed for 1 year after their initial visit. Survival analysis was used to calculate the risk of hyperglycemia requiring medical therapy and to identify potential risk factors. MAIN OUTCOME MEASURES: Initiation of hypoglycemic medications. RESULTS: Among 2073 non-diabetic patients treated with oral corticosteroids, 25 (1.21%) initiated hypoglycemic therapy compared with 5 of 2666 patients (0.19%) not treated with oral corticosteroids (relative risk [RR], 4.39; 95% confidence interval [CI], 1.68-11.5). The RR tended to be higher in association with higher initial doses (for initial doses <40 mg of prednisone per day: RR, 3.23; 95% CI, 1.08-9.64; for initial prednisone dose ≥40 mg/d: RR, 5.51; 95% CI, 2.01-15.1). Other risk factors for the initiation of hypoglycemic therapy included older age (RR [per each additional 10 years], 1.46; 95% CI, 1.15-1.85; P = 0.002) and African-American race (RR, 2.94; 95% CI, 1.34-6.43; P = 0.007). CONCLUSIONS: These results suggest that the absolute risk of corticosteroid-induced hyperglycemia that is detected and treated with hypoglycemic therapy in the tertiary ocular inflammation setting is low (an excess cumulative risk on the order of 1% within 1 year), although on a relative scale it is approximately 4.4-fold higher than in patients not treated with oral corticosteroids. Older age and African-American race also were risk factors. Physicians who use systemic corticosteroids for ocular inflammatory diseases should be aware of this risk, and should consider surveillance for hyperglycemia among high-risk patients. However, given the low absolute risk, routine laboratory monitoring or referral for monitoring may not be necessary for low-risk patients.
OBJECTIVE: To identify the incidence and risk factors for corticosteroid-induced hyperglycemia requiring medical therapy among patients with inflammatory eye diseases. DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with ocular inflammation followed at 5 United States tertiary centers that initially were neither diabetic nor taking hypoglycemic medications. METHODS: Eligible patients who used oral corticosteroids during follow-up were identified and followed longitudinally for initiation of hypoglycemic medication over 1 year after beginning corticosteroids. The remaining eligible patients were followed for 1 year after their initial visit. Survival analysis was used to calculate the risk of hyperglycemia requiring medical therapy and to identify potential risk factors. MAIN OUTCOME MEASURES: Initiation of hypoglycemic medications. RESULTS: Among 2073 non-diabeticpatients treated with oral corticosteroids, 25 (1.21%) initiated hypoglycemic therapy compared with 5 of 2666 patients (0.19%) not treated with oral corticosteroids (relative risk [RR], 4.39; 95% confidence interval [CI], 1.68-11.5). The RR tended to be higher in association with higher initial doses (for initial doses <40 mg of prednisone per day: RR, 3.23; 95% CI, 1.08-9.64; for initial prednisone dose ≥40 mg/d: RR, 5.51; 95% CI, 2.01-15.1). Other risk factors for the initiation of hypoglycemic therapy included older age (RR [per each additional 10 years], 1.46; 95% CI, 1.15-1.85; P = 0.002) and African-American race (RR, 2.94; 95% CI, 1.34-6.43; P = 0.007). CONCLUSIONS: These results suggest that the absolute risk of corticosteroid-induced hyperglycemia that is detected and treated with hypoglycemic therapy in the tertiary ocular inflammation setting is low (an excess cumulative risk on the order of 1% within 1 year), although on a relative scale it is approximately 4.4-fold higher than in patients not treated with oral corticosteroids. Older age and African-American race also were risk factors. Physicians who use systemic corticosteroids for ocular inflammatory diseases should be aware of this risk, and should consider surveillance for hyperglycemia among high-risk patients. However, given the low absolute risk, routine laboratory monitoring or referral for monitoring may not be necessary for low-risk patients.
Authors: D A Jabs; J T Rosenbaum; C S Foster; G N Holland; G J Jaffe; J S Louie; R B Nussenblatt; E R Stiehm; H Tessler; R N Van Gelder; S M Whitcup; D Yocum Journal: Am J Ophthalmol Date: 2000-10 Impact factor: 5.258
Authors: T Uzu; T Harada; M Sakaguchi; M Kanasaki; K Isshiki; S Araki; T Sugiomoto; D Koya; M Haneda; A Kashiwagi; A Yamauchi Journal: Nephron Clin Pract Date: 2006-11-29
Authors: John H Kempen; Ebenezer Daniel; Sapna Gangaputra; Kurt Dreger; Douglas A Jabs; R Oktay Kaçmaz; Siddharth S Pujari; Fahd Anzaar; C Stephen Foster; Kathy J Helzlsouer; Grace A Levy-Clarke; Robert B Nussenblatt; Teresa Liesegang; James T Rosenbaum; Eric B Suhler Journal: Ophthalmic Epidemiol Date: 2008 Jan-Feb Impact factor: 1.648
Authors: John H Kempen; Ebenezer Daniel; James P Dunn; C Stephen Foster; Sapna Gangaputra; Asaf Hanish; Kathy J Helzlsouer; Douglas A Jabs; R Oktay Kaçmaz; Grace A Levy-Clarke; Teresa L Liesegang; Craig W Newcomb; Robert B Nussenblatt; Siddharth S Pujari; James T Rosenbaum; Eric B Suhler; Jennifer E Thorne Journal: BMJ Date: 2009-07-03
Authors: Marc H Levin; Maxwell Pistilli; Ebenezer Daniel; Sapna S Gangaputra; Robert B Nussenblatt; James T Rosenbaum; Eric B Suhler; Jennifer E Thorne; C Stephen Foster; Douglas A Jabs; Grace A Levy-Clarke; John H Kempen Journal: Ophthalmology Date: 2013-12-12 Impact factor: 12.079
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