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Ophthalmology. 2012 Aug;119(8):1569-74. doi: 10.1016/j.ophtha.2012.01.043. Epub 2012 Apr 6.

Risk of corticosteroid-induced hyperglycemia requiring medical therapy among patients with inflammatory eye diseases.

Author information

  • 1The Ocular Inflammation Service and Center for Preventive Ophthalmology and Biostatistics, Department of Ophthalmology, The University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Abstract

OBJECTIVE:

To identify the incidence and risk factors for corticosteroid-induced hyperglycemia requiring medical therapy among patients with inflammatory eye diseases.

DESIGN:

Retrospective cohort study.

PARTICIPANTS:

Patients with ocular inflammation followed at 5 United States tertiary centers that initially were neither diabetic nor taking hypoglycemic medications.

METHODS:

Eligible patients who used oral corticosteroids during follow-up were identified and followed longitudinally for initiation of hypoglycemic medication over 1 year after beginning corticosteroids. The remaining eligible patients were followed for 1 year after their initial visit. Survival analysis was used to calculate the risk of hyperglycemia requiring medical therapy and to identify potential risk factors.

MAIN OUTCOME MEASURES:

Initiation of hypoglycemic medications.

RESULTS:

Among 2073 non-diabetic patients treated with oral corticosteroids, 25 (1.21%) initiated hypoglycemic therapy compared with 5 of 2666 patients (0.19%) not treated with oral corticosteroids (relative risk [RR], 4.39; 95% confidence interval [CI], 1.68-11.5). The RR tended to be higher in association with higher initial doses (for initial doses <40 mg of prednisone per day: RR, 3.23; 95% CI, 1.08-9.64; for initial prednisone dose ≥40 mg/d: RR, 5.51; 95% CI, 2.01-15.1). Other risk factors for the initiation of hypoglycemic therapy included older age (RR [per each additional 10 years], 1.46; 95% CI, 1.15-1.85; P = 0.002) and African-American race (RR, 2.94; 95% CI, 1.34-6.43; P = 0.007).

CONCLUSIONS:

These results suggest that the absolute risk of corticosteroid-induced hyperglycemia that is detected and treated with hypoglycemic therapy in the tertiary ocular inflammation setting is low (an excess cumulative risk on the order of 1% within 1 year), although on a relative scale it is approximately 4.4-fold higher than in patients not treated with oral corticosteroids. Older age and African-American race also were risk factors. Physicians who use systemic corticosteroids for ocular inflammatory diseases should be aware of this risk, and should consider surveillance for hyperglycemia among high-risk patients. However, given the low absolute risk, routine laboratory monitoring or referral for monitoring may not be necessary for low-risk patients.

Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

PMID:
22484116
[PubMed - indexed for MEDLINE]
PMCID:
PMC3394895
Free PMC Article

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