Steroid-induced impairment of glucose tolerance: Prevalence among pediatric patients on long-term steroid use in Nigeria

Un, Chikani; Ibekwe, RC; Oguonu, Tagbo; Mungai, Lucy N Wainaina; Bisi-Onyemaechi, AI; Ugege, OM; Ogbonna, Ikechukwu Frank; Beaufort, Carine de

doi:10.1111/pedi.12514

Cited by 3 publications

(3 citation statements)

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“…Previous studies have demonstrated some form of glucose metabolism disorders in adults with chronic steroid use for various conditions, with prevalence between 0.4% and 54%. [18,19] The prevalence has varied across studies and has been difficult to establish because of the variation in diagnostic criteria, length of follow-up, type of immunosuppression, and racial difference. There are few reports about medication-induced diabetes in pediatric patients with NS, although there are some reports on organ transplantation or hematological malignancy.…”

Section: Discussionmentioning

confidence: 99%

Glucose metabolism disorders in children with refractory nephrotic syndrome

et al. 2020

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Background: Patients with refractory nephrotic syndrome (NS) are at high risk of medication-induced glucose metabolism disorders, because of their long-term use of diabetogenic medications, particularly glucocorticoids and calcineurin inhibitors (CNIs). However, there have been no comprehensive evaluations of glucose metabolism disorders in pediatric patients with refractory NS. Moreover, glucocorticoids and CNIs could not be discontinued in these patients until the effectiveness of rituximab on refractory NS was shown and, therefore, there has been limited opportunity to evaluate glucose metabolism disorders after discontinuation of these medications. Methods: Consecutive pediatric patients who started rituximab treatment for refractory NS were enrolled.Their glucose metabolism conditions were evaluated using the oral glucose tolerance tests (OGTT) and HbA1c levels at the initiation of rituximab treatment. Patients with glucose metabolism disorders at the first evaluation were reevaluated after approximately 2 years.Results: Overall, 57% (20/35) of study patients had glucose metabolism disorders, and 40% (8/20) of these patients were detected only by their 2-hour OGTT blood glucose levels and not by their fasting blood glucose or HbA1c levels. Non-obese/non-overweight patients had significantly more glucose metabolism disorders than obese/overweight patients (p=0.019). In addition, glucose metabolism 3 disorders in 71% (10/14) of patients persisted after the discontinuation of glucocorticoids and CNIs.Conclusions: Whether the patient is obese/overweight or not, patients with refractory NS are at high risk of developing glucose metabolism disorders, even in childhood. Non-obese/non-overweight patients who are at high risk of diabetes need extra vigilance.

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Section: Discussionmentioning

confidence: 99%

Glucose metabolism disorders in children with refractory nephrotic syndrome

et al. 2020

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“…It is well known that GCS can impair glucose tolerance, mainly by inducing insulin resistance, and that the effects seem to be dose-dependent [26,27]. In addition, a possible causal role in direct beta-cell dysfunction has been suggested [28].…”

Section: Hy Induced By Gcsmentioning

confidence: 99%

Non-Diabetic Hyperglycemia in the Pediatric Age: Why, How, and When to Treat?

et al. 2018

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Purpose of review Non-diabetic hyperglycemia (NDHY) is a pathological condition that is not yet well known. The aim of this review is to examine approaches for management of this condition. Recent findings While it is well known that persistent hyperglycemia in diabetes affects immune response and risk for diabetesrelated micro-and macrovascular complications, little is known about the biological effects of transient NDHY, particularly in the pediatric age group. Summary Stress HY (SHY) is typically defined as blood glucose > 8.33 mmol/L (150 mg/dL) during physical stress, resolving spontaneously after dissipation of acute illness in patients without known diabetes. Based on the literature and clinical practice, two situations can be classified: (1) SHY1, which occurs during severe and prolonged illness and under serious life-threatening conditions, mainly in emergency situations and in resuscitation areas; and (2) SHY2, which occurs during acute illness, mainly in non-life-threatening conditions. Furthermore, (NDHY) among pediatric patients can be induced by drugs; the most frequent conditions are secondary to (1) steroid therapy and (2) antineoplastic/immunosuppressive therapy. Keywords Non-diabetic hyperglycemia . Stress hyperglycemia . Drug-induced hyperglycemia . Management This article is part of the Topical Collection on Pediatric Type 2 and Monogenic Diabetes * Enza Mozzillo

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“…In the severe forms of DCS, significant neurological, respiratory and circulatory deficits or failure are frequently involved, and steroids are routinely used due to their potency on inhibiting systemic inflammation, reducing capillary permeability, maintaining cell membrane and reducing tissue edema (Kizer, 1981). However, many studies have shown no significant improvement of DCS when treated with steroids (Dromsk et al, 2003;Montcalm-Smith et al, 2008), and may even worsen the outcome of central nervous system injury due to their adverse effect of elevating blood glucose (Chikani et al, 2017). Hence, there has been a decline in the use of steroids for the treatment of severe DCS as well as other critical diseases due to their adverse effects and uncertainty of outcomes (Dromsk et al, 2003;Felleiter et al, 2012;Gibbison et al, 2017;Walje et al, 2017;Oh et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Ulinastatin: A Potential Alternative to Glucocorticoid in the Treatment of Severe Decompression Sickness

Meng¹,

Qing²,

et al. 2020

Front. Physiol.

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Inflammatory reaction is the crux in various clinical critical diseases including decompression sickness (DCS). Ulinastatin (UTI), a potent anti-inflammatory agent, has been used clinically, including as a substitution for steroids. This study aimed to explore the potential effects of UTI upon DCS in a rabbit model. Eighty-eight rabbits were subjected to simulated diving to 6 atmospheres absolute (ATA) for 60 min with 2.5minute decompression. Three doses of UTI (15/7.5/3.75 × 10 5 U/kg) or saline were intravenously administered immediately following decompression. Circulating bubbles were monitored for 3 h following decompression and DCS signs were evaluated for 24 h. Blood was sampled 8 times during 72 h after decompression for inflammatory, endothelial, oxidative and routine blood indices. Lung tissues were also sampled for evaluating endothelial function. Another six rabbits were used as Normal controls. In the high dose UTI group the mortality, general morbidity and incidence of severe DCS was decreased from 31.25 to 9.38% (P = 0.030), 84.38 to 62.50% (P = 0.048) and 46.88 to 21.88% (P = 0.035), respectively. The high dose of UTI significantly postponed the occurrence of DCS (P = 0.030) and prolonged survival time (P = 0.009) compared with the Saline group, and significantly ameliorated inflammation responses, endothelial injuries and oxidative damage. The results strongly suggest the benefit of UTI on DCS, especially for severe cases. Large doses are needed to achieve significant effects. UTI may be a potential ideal pharmacological candidate for the treatment of severe DCS.

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Steroid-induced impairment of glucose tolerance: Prevalence among pediatric patients on long-term steroid use in Nigeria

Abstract: Low to moderate doses of oral and inhaled steroids should be used when indicated as they are associated with lesser risk of impairment of glucose tolerance in the pediatric population.

Cited by 3 publications

References 23 publications

Glucose metabolism disorders in children with refractory nephrotic syndrome

Glucose metabolism disorders in children with refractory nephrotic syndrome

Non-Diabetic Hyperglycemia in the Pediatric Age: Why, How, and When to Treat?

Ulinastatin: A Potential Alternative to Glucocorticoid in the Treatment of Severe Decompression Sickness

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