Sugiyama Takao, Sugimoto Toyohiko, Suzuki Sawako, Sato Yuta, Tanaka Tomoaki, Tatsuno Ichiro
Int J Clin Pharmacol Ther. 2015 Aug;53(8):616-20. doi: 10.5414/CP202136.
AIMS/INTRODUCTION: Although high-dose glucocorticoids have been reported to cause new-onset diabetes mellitus (glucocorticoid-induced diabetes mellitus), its risk factors have remained to be determined. We investigated the risk factors related to glucocorticoid-induced diabetes mellitus diagnosed within 2 months after the high-dose treatment (newly treated with an initial high dose of > 20 mg prednisolone (PSL) equivalent per day for at least more than 6 months) in collagen vascular diseases.
A total of 2,631 patients with collagen vascular diseases was registered between 1986 and 2006 in the Chiba-Shimoshizu Rheumatic Cohort. We analyzed 681 patients newly treated with high-dose glucocorticoid who did not have diabetes mellitus and/or its previous diagnosis (age: 46.3 ± 16.7 years, PSL dose: 40.0 ± 14.1 mg/day). Glucocorticoid-induced diabetes mellitus was diagnosed by two or more glucose measurements in patients with fasting glycaemia ≥ 7 mmol/L and 120 minutes post-load glycaemia ≥ 11.1 mmol/L.
Glucocorticoid-induced diabetes mellitus was observed in 26.3% of patients, and the glucocorticoid-induced diabetes mellitus group had higher age, higher BMI, lower rates of females and systemic lupus erythematosus, higher rates of smoking, alcohol use, and microscopic polyangiitis. Multivariate logistic regression analysis demonstrated that the risk of glucocorticoid-induced diabetes mellitus was independently higher in every 10-year increment of initial age with adjusted odds ratio (OR) 1.556 (95% confidence interval: 1.359 - 1.783), in every 1 kg/m2 increment of BMI with OR 1.062 (1.002 - 1.124), in current smoking with OR 1.664 (1.057 - 2.622), and in every 10 mg increment of initial dose of prednisolone with OR 1.250 (1.074 - 1.454).
High-dose glucocorticoids caused diabetes mellitus with high prevalence within a short period, and current smokers should be considered at higher risk of glucocorticoidinduced diabetes mellitus in addition to age, BMI, and initial dose.
目的/引言：尽管已有报道称高剂量糖皮质激素会引发新发糖尿病（糖皮质激素诱导的糖尿病），但其风险因素仍有待确定。我们调查了与胶原血管病中高剂量治疗后2个月内诊断出的糖皮质激素诱导的糖尿病（初始高剂量每天服用相当于泼尼松龙（PSL）>20毫克，持续至少6个月以上）相关的风险因素。
1986年至2006年期间，共有2631例胶原血管病患者在千叶下清水风湿队列中登记。我们分析了681例新接受高剂量糖皮质激素治疗且无糖尿病和/或既往诊断的患者（年龄：46.3±16.7岁，PSL剂量：40.0±14.1毫克/天）。空腹血糖≥7毫摩尔/升且负荷后120分钟血糖≥11.1毫摩尔/升的患者，通过两次或更多次血糖测量诊断为糖皮质激素诱导的糖尿病。
26.3%的患者出现了糖皮质激素诱导的糖尿病，糖皮质激素诱导的糖尿病组年龄更大、体重指数更高、女性和系统性红斑狼疮的比例更低、吸烟、饮酒和显微镜下多血管炎的比例更高。多因素逻辑回归分析表明，初始年龄每增加10岁，糖皮质激素诱导的糖尿病风险独立升高，调整后的优势比（OR）为1.556（95%置信区间：1.359 - 1.783）；体重指数每增加1千克/平方米，OR为1.062（1.002 - 1.124）；当前吸烟者的OR为1.664（1.057 - 2.622）；泼尼松龙初始剂量每增加10毫克，OR为1.250（1.074 - 1.454）。
高剂量糖皮质激素在短时间内导致糖尿病的患病率较高，除年龄、体重指数和初始剂量外，当前吸烟者应被视为糖皮质激素诱导的糖尿病风险更高。
