Steroid-induced diabetes in lupus nephritis patients: Classic risk factors or a different type of diabetes?

Abstract

Background: Glucocorticoids 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.

Purpose: The 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 sample: We included patients with biopsy-proven LN, who received induction treatment with steroids.

Data collection and/or analysis: Out of the total of 358 patients, 35 (9.7%) developed SID.

Results: Patients 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).

Conclusions: In 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.