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Joshua D. Udoetuk, Yang Dai, James T. Rosenbaum, Eric B. Suhler, Jennifer E. Thorne, C Stephen Foster, Douglas A. Jabs, Grace A. Levy-Clarke, Robert B. Nussenblatt, John H. Kempen; Risk Of Clinically Manifest Hyperglycemia Among Patients Receiving Systemic Corticosteroids For Inflammatory Eye Disease. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2748.
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Systemic corticosteroid therapy often is indicated for severe cases of ocular inflammation. Such therapy is known to predispose patients to numerous side effects including diabetes mellitus (DM). The purpose of this study was to identify the incidence and risk factors for corticosteroid-induced hyperglycemia requiring treatment among patients with inflammatory eye diseases.
The Systemic Immunosuppressive Therapy for Eye Diseases (SITE) Cohort is a large retrospective cohort of patients with non-infectious ocular inflammation seen at 5 tertiary centers in the U.S. In this analysis, SITE patients with no known history of DM were followed for initiation of hypoglycemic medication. Survival analysis was used to calculate the risk of hyperglycemia requiring treatment and to identify potential risk factors.
Among 2,073 eligible patients treated with oral corticosteroids, 25 (1.21%) initiated hypoglycemic therapy compared with 5 (0.19%) of 2,666 patients not treated with oral corticosteroids (relative risk (RR) = 4.39, 95% Confidence Interval (CI) = 1.68 - 11.5). 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).
These results suggest that systemic corticosteroids increase the risk of new onset DM requiring systemic therapy in patients with ocular inflammatory disorders approximately 4.4-fold, but suggest that the absolute risk of corticosteroid-induced hyperglycemia that is both detected and treated with hypoglycemic therapy is low (on the order of 1%). Higher age and African-American race also were risk factors. Ophthalmologists who use systemic corticosteroids for ocular inflammation should be aware of this risk and consider surveillance for hyperglycemia among high-risk patients.
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