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S. Feldman–Billard, R. Kassaei, B. Lissak, E. Heron; Pulse methylprednisolone for eye disease: effect on glucose tolerance in diabetic patients . Invest. Ophthalmol. Vis. Sci. 2004;45(13):5271.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose:We previously showed that the hyperglycemic effect of pulse methylprednisolone had no significant consequence in non diabetic patients. The aim of this study was to assess glucose tolerance during pulse methylprednisolone in patients with type 2 diabetes treated for ophthalmologic conditions. Methods: In our Eye Center, pulse therapy is managed according to a written protocol since 1995. We studied the records of all diabetic patients who received a 3–days course of pulse methylprednisolone between 1999 and 2002. Baseline markers of diabetes control (fasting glucose and glycosylated hemoglobin), main clinical characteristics, cardiovascular risk factors, and serial blood glucose measurements during therapy (at least five per day) were analyzed. Rapid–release insulin administration, given to patients with any glucose value over 14 mmol/l during blood glucose monitoring, was also recorded. Results:Eighty consecutive diabetic patients (mean age: 63 ± 15 yrs, 61 % men) received 250 to 1000 mg methylprednisolone per day during 3 days. The indications were ocular infectious diseases (n=20), corneal graft rejection (n=19), acute optic neuritis (n=15), severe uveitis (n=7) and miscellaneous (n=19). Each pulse was followed, about ten hours later, by a mean 100% peak increase of blood glucose from baseline fasting glucose (G0). In the whole study population, the peak glucose value after the first pulse (G1) was strongly associated with baseline markers of diabetes control (p<0.001), and not with any of the other clinical and biological parameters tested. Moreover, G1 could be predicted according to the formula: G1 (mmol/l) = 0.95 G0 (mmol/l) + 5.66 (r = 0.58; p<0.001). However, with similar baseline glycosylated hemoglobin values and methylprednisolone dosages, the risk of higher hyperglycemic increases (150 to 500% from baseline, N = 18) was associated with older age, female sex, dyslipidemia, high blood pressure, and diuretic treatment (p<0.05 each). Fifty one patients (64%) received rapid insulin during pulse therapy, including all 27 patients with glycosylated hemoglobin values > 8%. Conclusions: In diabetic patients, each pulse of methylprednisolone is followed on average by a doubling of baseline blood glucose value. Higher blood glucose rises are observed predominantly in older women, patients with associated cardiovascular risk factors, and/or diuretic treatment. These data provide a basis to predict rapid insulin requirements and to improve the management of diabetic patients treated by pulse therapy for ocular conditions.
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