Short-term effect of intravenous methylprednisolone pulse therapy on glycemic control in patients with normoglycemia and pre-diabetes

Authors

DOI:

https://doi.org/10.20883/medical.e435

Keywords:

Graves’ orbitopathy, glucocorticoids, methylprednisolone, glycemia, hyperglycemia

Abstract

Introduction. Systemic steroid therapy leads to disturbances in carbohydrate metabolism. The effect of immunosuppression with intravenous methylprednisolone (IVMP) pulses on glycaemia is not conclusive. Aim. This study aimed to assess the short-term effect of IVMP therapy in moderate-to-severe Graves' orbitopathy (GO) on glycaemic control in normoglycaemic patients with and without pre-diabetes. Material and Methods. Twenty-five GO patients treated with IVMP pulses (at initial dose of 6 x 0.5 g once a week, followed by 0.25 g given for 6 consecutive weeksweekly) were recruited and divided into a normoglycaemic group (n = 15, patients without pre-diabetes) and a pre-diabetic group (n = 10, patients with impaired fasting glycaemia (IFG) and/or impaired glucose tolerance (IGT)). Six daily capillary blood glucose measurements were performed at fixed times the day before and on the day of the first pulse administration. Results. There was a significant increase in the glucose concentration on the day of IVMP administration in both groups of patients compared to the day before drug administration, with 50% of patients showing an increase in blood glucose above 200 mg/dl. There were no statistically significant differences between the two groups. Conclusions. Methylprednisolone in a high intravenous dose has a tremendous impact on the blood glucose level in normoglycaemic and pre-diabetic patients on the day of drug administration.

Downloads

Download data is not yet available.

References

Boumpas DT, Chrousos G, Wilder R, Cupps T, Balow J. Glucocorticoid Therapy for Immune-Mediated Diseases: Basic and Clinical Correlates. Annals of Internal Medicine. 1993 Dec 15;119(12):1198-208. https://doi.org/10.7326/0003-4819-119-12-199312150-00007

Miśkiewicz P, Kryczka A, Ambroziak U, Rutkowska B, Główczyńska R, Opolski G, Kahaly G, Bednarczuk T. Is high dose intravenous methylprednisolone pulse therapy in patients with Graves' orbitopathy safe?. Endokrynol Pol. 2014;65(6):402-13. https://doi.org/10.5603/EP.2014.0056

Bartalena L, Baldeschi L, Boboridis K, Eckstein A, Kahaly GJ, Marcocci C, Perros P, Salvi M, Wiersinga WM. The 2016 European Thyroid Association/European Group on Graves' Orbitopathy Guidelines for the Management of Graves' Orbitopathy. European Thyroid Journal. 2016;5(1):9-26. https://doi.org/10.1159/000443828

Stiebel-Kalish H, Robenshtok E, Hasanreisoglu M, Ezrachi D, Shimon I, Leibovici L. Treatment Modalities for Graves’ Ophthalmopathy: Systematic Review and Metaanalysis. The Journal of Clinical Endocrinology & Metabolism. 2009 Aug 1;94(8):2708-16. https://doi.org/10.1210/jc.2009-0376

Marcocci C, Watt T, Altea MA, Rasmussen AK, Feldt-Rasmussen U, Orgiazzi J, Bartalena L, European Group of Graves' Orbitopathy. Fatal and non-fatal adverse events of glucocorticoid therapy for Graves' orbitopathy: a questionnaire survey among members of the European Thyroid Association. European Journal of Endocrinology. 2012 Feb;166(2):247-253. https://doi.org/10.1530/eje-11-0779

Moleti M, Giuffrida G, Sturniolo G, Squadrito G, Campennì A, Morelli S, Puxeddu E, Sisti E, Trimarchi F, Vermiglio F, Marinò M. Acute liver damage following intravenous glucocorticoid treatment for Graves’ ophthalmopathy. Endocrine. 2016 Mar 22;54(1):259-268. https://doi.org/10.1007/s12020-016-0928-3

Miśkiewicz P, Milczarek-Banach J, Rutkowska-Hinc B, Kondracka A, Bednarczuk T. High-dose intravenous methylprednisolone therapy in patients with Graves’ orbitopathy is associated with the increased activity of factor VIII. Journal of Endocrinological Investigation. 2018 Jun 9;42(2):217-225. https://doi.org/10.1007/s40618-018-0907-z

Miskiewicz P, Milczarek-Banach J, Bednarczuk T, Opolski G, Glowczynska R. Blood Pressure Profile and N-Terminal-proBNP Dynamics in Response to Intravenous Methylprednisolone Pulse Therapy of Severe Graves’ Orbitopathy. International Journal of Molecular Sciences. 2018 Sep 26;19(10):2918. https://doi.org/10.3390/ijms19102918

Miśkiewicz P, Jankowska A, Brodzińska K, Milczarek-Banach J, Ambroziak U. Influence of Methylprednisolone Pulse Therapy on Liver Function in Patients with Graves’ Orbitopathy. International Journal of Endocrinology. 2018 Oct 21;2018:1-9. https://doi.org/10.1155/2018/1978590

Suh S, Park MK. Glucocorticoid-Induced Diabetes Mellitus: An Important but Overlooked Problem. Endocrinology and Metabolism. 2017;32(2):180. https://doi.org/10.3803/enm.2017.32.2.180

Clore J, Thurby-Hay L. Glucocorticoid-Induced Hyperglycemia. Endocrine Practice. 2009 Jul;15(5):469-474. https://doi.org/10.4158/ep08331.rar

Feldman-Billard S, Lissak B, Benrabah R, Kassaei R, Héron E. Intravenous pulse methylprednisolone therapy in eye disease. Ophthalmology. 2003 Dec;110(12):2369-2371. https://doi.org/10.1016/s0161-6420(03)00818-2

Feldman-Billard S, Lissak B, Kassaei R, Benrabah R, Héron E. Short-term tolerance of pulse methylprednisolone therapy in patients with diabetes mellitus. Ophthalmology. 2005 Mar;112(3):511-515. https://doi.org/10.1016/j.ophtha.2004.10.032

Perez TH, de Ossio GM, Flores QD, Coria HM, Peña TA, Coria HM, Pérez CG, Peña PS. Glucose disturbances in non-diabetic patients receiving acute treatment with methylprednisolone pulses. Rev Assoc Med Bras (1992). 2012 Jan-Feb;58(1):125-8. Rev Assoc Med Bras (1992). 2012 Jan-Feb;58(1):125-8. PMID 22392327

Martinez Martinez M, Abud-Mendoza C, Martínez-Lozano J, Acevedo-Castañeda E, Herrera-van Oostdam D. AB1025 Glycemia and Systemic Blood Pressure in Patients Who Receive Corticosteroid Pulse Therapy. Annals of the Rheumatic Diseases. 2016 Jun;75(Suppl 2):1252.2-1252. https://doi.org/10.1136/annrheumdis-2016-eular.6082

Tanaka K, Okada Y, Mori H, Torimoto K, Arao T, Tanaka Y. The Effects of Mitiglinide and Repaglinide on Postprandial Hyperglycemia in Patients Undergoing Methylprednisolone Pulse Therapy. Internal Medicine. 2018;57(1):65-70. https://doi.org/10.2169/internalmedicine.9013-17

Loader J, Montero D, Lorenzen C, Watts R, Méziat C, Reboul C, Stewart S, Walther G. Acute Hyperglycemia Impairs Vascular Function in Healthy and Cardiometabolic Diseased Subjects. Arteriosclerosis, Thrombosis, and Vascular Biology. 2015 Sep;35(9):2060-2072. https://doi.org/10.1161/atvbaha.115.305530

Yang Z, Laubach VE, French BA, Kron IL. Acute hyperglycemia enhances oxidative stress and exacerbates myocardial infarction by activating nicotinamide adenine dinucleotide phosphate oxidase during reperfusion. The Journal of Thoracic and Cardiovascular Surgery. 2009 Mar;137(3):723-729. https://doi.org/10.1016/j.jtcvs.2008.08.056

Lemkes B, Hermanides J, Devries J, Holleman F, Meijers J, Hoekstra J. Hyperglycemia: a prothrombotic factor?. Journal of Thrombosis and Haemostasis. 2010 May 12;8(8):1663-1669. https://doi.org/10.1111/j.1538-7836.2010.03910.x

Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, Federici M, Filippatos G, Grobbee DE, Hansen TB, Huikuri HV, Johansson I, Jüni P, Lettino M, Marx N, Mellbin LG, Östgren CJ, Rocca B, Roffi M, Sattar N, Seferović PM, Sousa-Uva M, Valensi P, Wheeler DC, Piepoli MF, Birkeland KI, Adamopoulos S, Ajjan R, Avogaro A, Baigent C, Brodmann M, Bueno H, Ceconi C, Chioncel O, Coats A, Collet J, Collins P, Cosyns B, Di Mario C, Fisher M, Fitzsimons D, Halvorsen S, Hansen D, Hoes A, Holt RIG, Home P, Katus HA, Khunti K, Komajda M, Lambrinou E, Landmesser U, Lewis BS, Linde C, Lorusso R, Mach F, Mueller C, Neumann F, Persson F, Petersen SE, Petronio AS, Richter DJ, Rosano GMC, Rossing P, Rydén L, Shlyakhto E, Simpson IA, Touyz RM, Wijns W, Wilhelm M, Williams B, Aboyans V, Bailey CJ, Ceriello A, Delgado V, Federici M, Filippatos G, Grobbee DE, Hansen TB, Huikuri HV, Johansson I, Jüni P, Lettino M, Marx N, Mellbin LG, Östgren CJ, Rocca B, Roffi M, Sattar N, Seferović PM, Sousa-Uva M, Valensi P, Wheeler DC, Windecker S, Aboyans V, Baigent C, Collet J, Dean V, Delgado V, Fitzsimons D, Gale CP, Grobbee DE, Halvorsen S, Hindricks G, Iung B, Jüni P, Katus HA, Landmesser U, Leclercq C, Lettino M, Lewis BS, Merkely B, Mueller C, Petersen SE, Petronio AS, Richter DJ, Roffi M, Shlyakhto E, Simpson IA, Sousa-Uva M, Touyz RM, Zelveian PH, Scherr D, Jahangirov T, Lazareva I, Shivalkar B, Naser N, Gruev I, Milicic D, Petrou PM, Linhart A, Hildebrandt P, Hasan-Ali H, Marandi T, Lehto S, Mansourati J, Kurashvili R, Siasos G, Lengyel C, Thrainsdottir IS, Aronson D, Di Lenarda A, Raissova A, Ibrahimi P, Abilova S, Trusinskis K, Saade G, Benlamin H, Petrulioniene Z, Banu C, Magri CJ, David L, Boskovic A, Alami M, Liem AH, Bosevski M, Svingen GFT, Janion M, Gavina C, Vinereanu D, Nedogoda S, Mancini T, Ilic MD, Fabryova L, Fras Z, Jiménez-Navarro MF, Norhammar A, Lehmann R, Mourali MS, Ural D, Nesukay E, Chowdhury TA. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. European Heart Journal. 2019 Aug 31;41(2):255-323. https://doi.org/10.1093/eurheartj/ehz486

Gulliford M, Charlton J, Latinovic R. Risk of Diabetes Associated With Prescribed Glucocorticoids in a Large Population. Diabetes Care. 2006 Nov 27;29(12):2728-2729. https://doi.org/10.2337/dc06-1499

How to Cite

1.
Mitkowska K, Pelewicz K, Walasik I, Szewczyk S, Miśkiewicz P. Short-term effect of intravenous methylprednisolone pulse therapy on glycemic control in patients with normoglycemia and pre-diabetes. JMS [Internet]. 2020 Jun. 30 [cited 2023 Feb. 4];89(2):e435. Available from: https://jms.ump.edu.pl/index.php/JMS/article/view/435

Issue

Section

Original Papers
Received 2020-05-27
Accepted 2020-06-08
Published 2020-06-30