Marić Andreja, Miličević Tanja, Vučak Lončar Jelena, Galušić Davor, Radman Maja
Department of Internal Medicine, County Hospital Čakovec, Čakovec 40000, Croatia.
Department of Internal Medicine, University Hospital Center Split, Split 21000, Croatia.
Int J Gen Med. 2020 Apr 15;13:131-140. doi: 10.2147/IJGM.S245779. eCollection 2020.
This cohort study aimed to determine patterns of glycemic fluctuation and changes in metabolic parameters during and after corticosteroid administration in newly diagnosed diffuse large B-cell lymphoma (DLBCL) patients treated with R-CHOP chemotherapy.
The study was performed in 20 patients of whom 11 had diabetes and 9 were nondiabetics. Anthropometric parameters were collected, and blood samples were taken four times during the study to analyze metabolic parameters. Capillary glucose was measured seven times a day (fasting, before mean meals, postprandial, and before bedtime) to evaluate the glycemic profile.
In all 20 patients, acute glucocorticoid administration resulted in the elevation of average glucose levels, dominantly postprandial in the afternoon which correlates with corticosteroid peak action. In 7 out of 11 diabetics, prandial insulin was started during corticosteroid administration and discontinued afterward. Although none of our nondiabetic patients met diabetes criteria, evident is the elevation in average glycemia levels six weeks after corticosteroid administration. Potentially, even transient corticosteroid administration reduces insulin sensitivity and contributes to later glycemic disturbances. HbA1c levels were higher at the end of the study while fructosamine levels were higher during the study.
Patients and health-care professionals need to be aware of corticosteroid-induced hyperglycemia. We recommend identifying risk factors, measuring glycemia before, during, and after corticosteroid administration, and starting the adequate therapy as soon as possible.
本队列研究旨在确定接受R-CHOP化疗的新诊断弥漫性大B细胞淋巴瘤（DLBCL）患者在使用皮质类固醇期间及之后的血糖波动模式和代谢参数变化。
该研究纳入了20例患者，其中11例患有糖尿病，9例为非糖尿病患者。收集人体测量参数，并在研究期间采集4次血样以分析代谢参数。每天测量7次毛细血管血糖（空腹、三餐前、餐后和睡前）以评估血糖情况。
在所有20例患者中，急性给予糖皮质激素导致平均血糖水平升高，主要是下午餐后血糖升高，这与皮质类固醇的峰值作用相关。11例糖尿病患者中有7例在使用皮质类固醇期间开始使用餐时胰岛素，之后停用。虽然我们的非糖尿病患者均未达到糖尿病标准，但在使用皮质类固醇6周后平均血糖水平明显升高。潜在地，即使是短暂使用皮质类固醇也会降低胰岛素敏感性并导致后期血糖紊乱。研究结束时糖化血红蛋白（HbA1c）水平较高，而在研究期间果糖胺水平较高。
患者和医护人员需要意识到皮质类固醇诱发的高血糖。我们建议识别危险因素，在使用皮质类固醇之前、期间和之后测量血糖，并尽快开始适当治疗。
