[Diagnosis and therapy of steroid-induced hyperglycemia based on literature reports]

The increase of the incidence of autoimmune diseases leads to a growing number of patients treated with immunosuppressants. One of the main group of drugs used in immunosuppression are glucocorticoids, which are connected with a significant risk of glucose tolerance disorders. It seems that a decisive role in the hyperglycemic activity plays a reduction of peripheral glucose uptake at the level of skeletal muscle, but in case of higher doses of glucocorticosteroids, stimulation of hepatic glucose production can be dominant. The diagnosis of glucocorticoid-induced diabetes is not different from the generally accepted criteria. There are not commonly accepted diagnostic and therapeutic rules in this area. The majority of hyperglycaemia cases in patients treated with high doses of glucocorticosteroids occur within the first 48 hours after start of glucocorticoids therapy. The closely monitoring of glucose profile should be performed in this time period. In the case of prolonged glucocorticoids treatment, regularly assessment of postprandial glucose and periodically performed oral glucose tolerance test is recommended. The diagnostic significance of glycated hemoglobin in this area has been not yet determined. The therapeutic targets are adequate as for type 2 diabetes. Pharmacological treatment should be implemented when glucose values reach up above 12mmol/l (216mg/dl) twice a day. The therapeutic hopes are connected with the use of new classes of drugs, in particular with incretin-drugs, especially with glucagon-like peptide (GLP) -1 receptor agonists. When the therapy goals are not able to achieve, the insulin treatment should be implemented.