[Glucocorticoids and diabetes mellitus].

Area of Science:

• Endocrinology
• Metabolic Disorders

Context:

• Glucocorticoids (GCs) are potent medications with significant metabolic side effects.
• The diabetogenic potential of GCs varies based on dose, duration, preparation type, and individual factors.
• GC effects are modulated by glucocorticoid receptor status and circadian rhythms.

Purpose:

• To elucidate the mechanisms underlying GC-induced diabetes mellitus.
• To explore factors influencing GC diabetogenicity, including patient age and endocrine function.
• To review current and emerging therapeutic strategies for managing GC-induced hyperglycemia.

Summary:

• GC-induced diabetes results from the interplay between GC dose, duration, preparation, receptor sensitivity, and administration timing.
• Impaired glucose tolerance or diabetes develops when pancreatic islet cells cannot overcome GC-induced insulin resistance.
• Age-related decline in islet compensatory function increases susceptibility to steroid diabetes, especially in older adults.
• Treatment options include sulfonylureas, insulin, thiazolidinediones, metformin, alpha-glucosidase inhibitors, and potentially antiglucocorticoids.

Impact:

• Understanding GC diabetogenicity is crucial for optimizing patient care and minimizing adverse metabolic outcomes.
• This knowledge aids in developing personalized treatment approaches for patients requiring glucocorticoid therapy.
• Highlights the importance of monitoring glucose metabolism in patients on long-term glucocorticoid treatment.