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K. Maruyama, E. Arimura, F. Tanabe, C. Matsumoto, Y. Shimomura; Management of Glucose Intolerance and Hyperlipidemia in Patients Receiving Systemic Corticosteroid Therapy for Uveitis. Invest. Ophthalmol. Vis. Sci. 2008;49(13):3886.
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High-dose and long-term systemic corticosteroid (SCS) therapy for patients with uveitis may induce the onset or the exacerbation of diabetes mellitus (DM) and hyperlipidemia (HLD). We investigated how the complications of DM and HLD in the course of SCS therapy could be managed by determining glucose tolerance and following lipidosis.
Non-comparative prospective analysis was performed on 46 patients with uveitis, who received SCS therapy. Patient’s glucose tolerance by oral glucose tolerance test (OGTT, 75g), total cholesterol (T-cho), and triglyceride (TG) in the blood were evaluated before treatment, and on 3 and 6 months after the beginning of SCS therapy. The main outcome parameters evaluated included OGTT result, fasting glucose, T-cho, TG, and additional treatment for the complications.
Subjects were 46 patients (19 males, 27 females) with a median age of 47.1 years (range, 14-72 years) with Vogt-Koyanagi-Harada disease (25 patients), sarcoidosis (7 patients), retinal vasculitis (3 patients), human T cell lymphotropic virus type 1 associated uveitis (2 patients), tubulointerstitial nephritis and uveitis syndrome (1 patient), or idiopathic uveitis (8 patients). Before SCS therapy, 19 patients (41%) had abnormal results of OGTT. Of whom, 14 patients (30%) had impaired glucose tolerance (IGT) and 5 patients (11%) had DM. Regardless of the OGTT findings, 13 of the 19 patients showed normal fasting glucose. On 3 and 6 months after the SCS treatment started, elevation of impaired fasting glucose (IFG) was observed in 11 patients and additional diabetic therapy was given to those 5 patients with DM. Before SCS therapy, high levels of T-cho and TG were observed in 22 (48%) and 11 (24%) patients, respectively. Among them, 8 patients (17%) were affected with hypercholesterolemia and 9 patients (20%) were diagnosed as hypertrigryceridemia during the treatment period. Furthermore, additional therapy with 3-hydroxy-3-methylglutaryl coenzyme-A reductase inhibitor was combined with the SCS therapy in 12 of the 17 patients, and the therapy for HLD had lowered the levels of T-cho and TG to the normal range in 7 patients.
For better therapeutic result, IGT, DM and HLD should be verified before the treatment for uveitis started and during the treatment period.
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