关键词: 糖皮质激素类, 糖尿病, 危险因素, 类固醇糖尿病

Abstract: Hua You, Wang Min, Gao Yali, Geng Qingwei, Xiang Wenzhong, Song Xiuzu Department of Dermatology, Hangzhou Third People′s Hospital, Hangzhou Clinical College Affiliated to Anhui Medical University, Hangzhou 310009, China Corresponding author: Song Xiuzu, Email: songxiuzu@sina.com 【Abstract】 Objective To investigate risk factors for and clinical features of steroid-induced diabetes mellitus due to glucocorticoid treatment. Methods Clinical data were collected from 798 patients who received systemic glucocorticoid treatment in Department of Dermatology of Hangzhou Third People′s Hospital from 2013 to 2016, and analyzed retrospectively. Logistic regression analysis was performed to analyze the factors influencing the occurrence of steroid-induced diabetes mellitus （SDM）, repeated-measures analysis of variance to compare peripheral blood glucose levels of patients with SDM after breakfast, lunch and dinner, and t test to compare the levels of fasting blood glucose and glycosylated hemoglobin （HbA1c） between patients with SDM and those with type 2 diabetes mellitus. Results Of the 798 patients, 38 developed SDM due to glucocorticoid treatment. The average age was significantly older in the patients with SDM （［66.86 ± 13.30］ years, n = 38） than in those without SDM （［39.95 ± 17.01］ years, n = 760; t = 8.86, P < 0.01）, but there was no significant difference in the gender ratio between the patients with and thhose without SDM （χ2 = 1.61, P = 0.20）. The prevalence of fatty liver, hyperlipidemia, hypertension, abnormal liver function and family history of diabetes mellitus was significantly higher in the patients with SDM than in those without SDM （χ2 = 12.25, 19.25, 32.69, 21.47, 16.70 respectively, all P < 0.01）. Logistic regression analysis showed that age, fatty liver, hyperlipidemia, hypertension, abnormal liver function, dosage of glucocorticoids, duration of glucocorticoid therapy, use of immunosuppressive agents and family history of diabetes mellitus were risk factors for SDM （all P < 0.05）. There were no significant differences in fasting blood glucose levels or postprandial peripheral blood glucose levels among the SDM patients receiving glucocorticoid therapy at different dosages of 0.50 - 0.74, 0.75 - 0.99, 1.00 - 1.25 mg·kg-1·d-1 （P > 0.05）. The peripheral blood glucose levels after breakfast, lunch and dinner were （11.50 ± 2.90）, （16.02 ± 5.81） and （16.81 ± 4.52） mmol/L respectively in the patients with SDM. The levels of fasting blood glucose and glycosylated HbA1c were both significantly lower in the patients with SDM than in those with type 2 diabetes mellitus（t = 3.74, 9.92 respectively, both P < 0.001）. Conclusions The risk factors for SDM are age, dosage of glucocorticoids, duration of glucocorticoid therapy, fatty liver, hyperlipidemia, hypertension, abnormal liver function, use of immunosuppressive agents and family history of diabetes mellitus. The patients with SDM showed obviously elevated blood glucose levels mostly after lunch and dinner, but slightly increased levels of fasting blood glucose and glycosylated HbA1c, which can be used to distinguish between SDM and type 2 diabetes mellitus.

Key words: Glucocorticoids, Diabetes mellitus, Risk factors, Steroid diabetes