Cristian Alejandro Dimas-Ramírez, Luis André Fortanell-Meza, Diego San Agustín-Morales, Eduardo Brenner-Muslera, Juan Manuel Mejía-Vilet, Paloma Almeda-Valdes, Paola Vázquez-Cárdenas, Javier Merayo-Chalico, Ana Barrera-Vargas
{"title":"Steroid-induced diabetes in lupus nephritis patients: Classic risk factors or a different type of diabetes?","authors":"Cristian Alejandro Dimas-Ramírez, Luis André Fortanell-Meza, Diego San Agustín-Morales, Eduardo Brenner-Muslera, Juan Manuel Mejía-Vilet, Paloma Almeda-Valdes, Paola Vázquez-Cárdenas, Javier Merayo-Chalico, Ana Barrera-Vargas","doi":"10.1177/09612033251315976","DOIUrl":null,"url":null,"abstract":"<p><p>BackgroundGlucocorticoids are frequently employed in systemic lupus erythematosus (SLE) patients and play a critical role in the induction therapy of lupus nephritis (LN), despite their many side effects, including steroid-induced diabetes (SID). Information regarding SID in SLE patients is quite scant.PurposeThe aim of this study was to determine risk factors associated with the development of SID in patients with LN.Research Design A nested case-control study was conducted.Study sampleWe included patients with biopsy-proven LN, who received induction treatment with steroids.Data Collection and/or AnalysisOut of the total of 358 patients, 35 (9.7%) developed SID.ResultsPatients with SID had more metabolic risk factors, including the metabolic score for insulin resistance (METS-IR); more factors related with lupus activity, with higher SLEDAI and SLICC-DI scores; and lower cumulative pre-induction steroid dose. A higher percentage of patients who developed SID received steroid pulses and a lower percentage received antimalarials. After logistic regression, the variables significantly associated with the development of SID were the SLEDAI index (OR 1.25 [95% CI 1.04-1.50], <i>p</i> 0.01), SLICC-DI (OR 4.93 [95% CI 2.14-11.3], <i>p</i> < 0.001), METS-IR (OR 1.17 [95% CI 1.04-1.32], <i>p</i> 0.009), delta METS-IR at 6 months (OR 1.20 [95% CI 1.03-1.39], <i>p</i> 0.01), and the use of antimalarials (OR 0.14, [95% CI 0.02-0.85], <i>p</i> 0.03). After propensity score matching, METS-IR remained a significant predictor of SID. Patients with METS-IR >36.8 were at higher risk (OR: 2.83, 95% CI: 1.09-7.36, <i>p</i> = 0.034).ConclusionsIn conclusion, SDI development in patients receiving induction therapy for LN is associated with both classic metabolic risk factors and SLE-specific factors, and antimalarial use could be associated with a protective effect. Rheumatologists should be aware of this potential complication, in order to implement appropriate management strategies.</p>","PeriodicalId":18044,"journal":{"name":"Lupus","volume":" ","pages":"234-242"},"PeriodicalIF":1.9000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lupus","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/09612033251315976","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/22 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
BackgroundGlucocorticoids are frequently employed in systemic lupus erythematosus (SLE) patients and play a critical role in the induction therapy of lupus nephritis (LN), despite their many side effects, including steroid-induced diabetes (SID). Information regarding SID in SLE patients is quite scant.PurposeThe aim of this study was to determine risk factors associated with the development of SID in patients with LN.Research Design A nested case-control study was conducted.Study sampleWe included patients with biopsy-proven LN, who received induction treatment with steroids.Data Collection and/or AnalysisOut of the total of 358 patients, 35 (9.7%) developed SID.ResultsPatients with SID had more metabolic risk factors, including the metabolic score for insulin resistance (METS-IR); more factors related with lupus activity, with higher SLEDAI and SLICC-DI scores; and lower cumulative pre-induction steroid dose. A higher percentage of patients who developed SID received steroid pulses and a lower percentage received antimalarials. After logistic regression, the variables significantly associated with the development of SID were the SLEDAI index (OR 1.25 [95% CI 1.04-1.50], p 0.01), SLICC-DI (OR 4.93 [95% CI 2.14-11.3], p < 0.001), METS-IR (OR 1.17 [95% CI 1.04-1.32], p 0.009), delta METS-IR at 6 months (OR 1.20 [95% CI 1.03-1.39], p 0.01), and the use of antimalarials (OR 0.14, [95% CI 0.02-0.85], p 0.03). After propensity score matching, METS-IR remained a significant predictor of SID. Patients with METS-IR >36.8 were at higher risk (OR: 2.83, 95% CI: 1.09-7.36, p = 0.034).ConclusionsIn conclusion, SDI development in patients receiving induction therapy for LN is associated with both classic metabolic risk factors and SLE-specific factors, and antimalarial use could be associated with a protective effect. Rheumatologists should be aware of this potential complication, in order to implement appropriate management strategies.
期刊介绍:
The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…