Glucose tolerance disorders during treatment with glucocorticoids in patients with inflammatory diseases of the musculoskeletal system - based on the analysis of data from the literature and own research results.

Abstract

Glucocorticoids are among the most frequently used anti-inflammatory and immunosuppressive drugs. They are widely used in the treatment of numerous autoimmune disorders. However, the treatment with glucocorticoids is connected with the risk of a number of side effects. Among them, glucose tolerance disorders play an important role. The results of meta-analyses show that the risk of diabetes is from 1.4 to 2.5 times higher in the case of treated patients in comparison to the general population. Glucocorticoids can directly impair pancreatic β-cell secretion. Nevertheless, a crucial role in the hyperglycemic activity seems to be played by a peripheral glucose uptake reduction, principally in the skeletal muscle, which is responsible for the decrease of insulin sensitivity, and can manifest itself in the increase of postprandial blood glucose levels. If they are used in higher doses and for a prolonged period, they can also reduce the inhibitory effect of insulin on hepatic glucose production, which can lead to an increase of fasting plasma glucose. Numerous literature data indicate that in the case of patients who suffer from inflammatory diseases of the musculoskeletal system, the treatment with low to moderate doses of glucocorticoids, for a short period, does not significantly increase the metabolic risk. The beneficial role in this area may be connected with an anti-inflammatory and immunosuppressive effect. The regular assessment of the postprandial glucose, especially in the afternoon and evening, has the highest diagnostic sensitivity of glucocorticoid-induced glucose tolerance disorders. In the case of patients without a prior diagnosis of diabetes, after discontinuation of treatment, the oral glucose tolerance test should be considered in order to identify the presence of persistent disorders.