Glucocorticoid-Induced Insulin Resistance and Its Intervention in Children with Refractory Nephrotic Syndrome

The side effects of glucocorticoid-induced insulin resistance (IR) have drawn increasing attention, but the information is scarce regarding treatment of glucocorticoid-induced insulin resistance in children. The study was conducted in children who received prolonged high-dose glucocorticoid for refractory nephrotic syndrome. The Body Mass Index (BMI) was monitored and metabolic parameters were determined. Homeostatic model assessment for insulin resistance index (HOMA-IR) was used for assessing glucocorticoid-induced IR. There were 41 obese children with HOMA-IR>3.5. The HOMA-IR showed a positive correlation with prednisone dosage, LDL-C, age and BMI (P<0.01), respectively. Multiple linear regression analysis showed that prednisone dosage, LDL-C, age and BMI correlated independently with HOMA-IR (P<0.05). Twenty-one children received metformin therapy as treated group and 20 patients received placebo as control group. After 3 months of treatment, the BMI and IR were significantly improved and the BMI and HOMA-IR were also significantly reduced compared to the control group. No significant toxicity from metformin was seen. Metformin is safe and effective for treatment of glucocorticoid-induced obesity and IR.