Matthew D Wallace1, Nicole L Metzger1,2. 1. 1 Emory University Hospital, Atlanta, GA, USA. 2. 2 Mercer University College of Pharmacy, Atlanta, GA, USA.
Abstract
OBJECTIVE: To review therapeutic strategies for the management of patients with steroid-induced hyperglycemia. DATA SOURCES: A literature search of MEDLINE/PubMed (1990 to June 2017) was conducted using the search terms steroid, glucocorticoid, corticosteroid, hyperglycemia, and diabetes as well via review of literature citations. STUDY SELECTION AND DATA EXTRACTION: Relevant clinical trials and case studies focusing on pharmacological interventions in humans were reviewed for inclusion. Articles discussing islet cell transplant were excluded. DATA SYNTHESIS: Hyperglycemia is a predictable adverse effect of glucocorticoid therapy, which is associated with negative outcomes, including an odds ratio of 1.36 for developing new-onset diabetes. A variety of strategies have been utilized for managing patients who are at risk of complications caused by steroid-induced hyperglycemia. Agents such as sulfonylureas, thiazolidinediones, meglitinides, metformin, dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptidase-1 agonists, and insulin have been evaluated in case studies and small clinical trials with varying degrees of success. CONCLUSIONS: Since there are limited clinical data available to guide therapy, strategies that minimize the risk of adverse effects should be selected for the management of steroid-induced hyperglycemia. Therapies that may be safe and effective given current information include DPP-4 inhibitors, metformin, and weight-based neutral protamine Hagedorn insulin.
OBJECTIVE: To review therapeutic strategies for the management of patients with steroid-induced hyperglycemia. DATA SOURCES: A literature search of MEDLINE/PubMed (1990 to June 2017) was conducted using the search terms steroid, glucocorticoid, corticosteroid, hyperglycemia, and diabetes as well via review of literature citations. STUDY SELECTION AND DATA EXTRACTION: Relevant clinical trials and case studies focusing on pharmacological interventions in humans were reviewed for inclusion. Articles discussing islet cell transplant were excluded. DATA SYNTHESIS: Hyperglycemia is a predictable adverse effect of glucocorticoid therapy, which is associated with negative outcomes, including an odds ratio of 1.36 for developing new-onset diabetes. A variety of strategies have been utilized for managing patients who are at risk of complications caused by steroid-induced hyperglycemia. Agents such as sulfonylureas, thiazolidinediones, meglitinides, metformin, dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptidase-1 agonists, and insulin have been evaluated in case studies and small clinical trials with varying degrees of success. CONCLUSIONS: Since there are limited clinical data available to guide therapy, strategies that minimize the risk of adverse effects should be selected for the management of steroid-induced hyperglycemia. Therapies that may be safe and effective given current information include DPP-4 inhibitors, metformin, and weight-based neutral protamine Hagedorn insulin.
Entities:
Keywords:
antihyperglycemics; corticosteroids; diabetes; endocrinology; insulin; type 2
Authors: Ashley M Lato; Susan J Burke; Maggie P Ducote; Brandon J Kennedy; J Jason Collier; Shawn R Campagna Journal: ACS Med Chem Lett Date: 2022-08-22 Impact factor: 4.632
Authors: Brandon J Kennedy; Ashley M Lato; Alexander R Fisch; Susan J Burke; Justin K Kirkland; Carson W Prevatte; Lee E Dunlap; Russell T Smith; Konstantinos D Vogiatzis; J Jason Collier; Shawn R Campagna Journal: ACS Med Chem Lett Date: 2021-09-15 Impact factor: 4.632