What You Should Know about Anti-inflammatory Steroids and Type 2 Diabetes

Anti-inflammatory steroids and type 2 diabetes
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Previous research has indicated that high doses of anti-inflammatory steroids are associated with an increased risk of developing type 2 diabetes, among other dangers. Now it appears that low doses of these drugs also are linked to a greater risk of this common disease.

Doctors write millions of prescriptions for anti-inflammatory steroids for diseases and health problems ranging from arthritis to asthma, chronic obstructive pulmonary disease, cystic fibrosis, inflammatory bowel disease, lower back pain, and lupus, among others that involve inflammation and pain. Oral steroids (or glucocorticosteroids) include methylprednisolone, prednisolone, and prednisone, while inhaled forms include beclomethsone, budesonide, flunisolide, fluticasone, and triamcinolone.

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It has been established that oral anti-inflammatory steroids taken in high doses can raise blood sugar levels. Other adverse effects can include weight gain, development of osteoporosis, cataracts, swollen feet or ankles, and skin bruising.

But according to Dr. Carolyn Petersons and her team at Flinders University, nine patients with rheumatoid arthritis who were given a low dose (6 mg/day) of prednisolone for just 7 to 10 days showed an increase in their sugar levels. More specifically, use of low-dose steroids made the patients less sensitive to insulin, which in turn caused the body to accumulate sugar in the blood and increased the risk of developing diabetes.

The association between low-dose anti-inflammatory steroids and type 2 diabetes is important for several reasons. One, it suggests doctors and patients should reconsider the use of anti-inflammatory steroids, especially by anyone who has other risk factors for type 2 diabetes. Doctors and patients should discuss other treatment options, including lifestyle changes.

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Two, it alerts physicians to the possibility of steroid-induced diabetes. Three, knowing that steroids have an impact on insulin sensitivity may help researchers develop new ways to fight the causes of type 2 diabetes.

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Other steroid and diabetes studies
Numerous other studies have examined the relationship between oral anti-inflammatory steroid use and diabetes. Here are a few of them.

Forty-one patients with early rheumatoid arthritis who had not yet been treated for the disease were given high-dose prednisolone (either 60 mg/day or 30 mg/day) for one week. At the start of the study, 56 percent of the participants had impaired glucose tolerance and 7 percent were diagnosed with previously unrecognized type 2 diabetes.

At the end of the week of prednisolone use, the incidence of type 2 diabetes increased to 24 percent, with the response being about equal between the two dosage groups.

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In a study of medium-dose (20 mg/day) anti-inflammatory steroids (prednisone), three small groups of participants were studied. One group had type 2 diabetes (7 individuals), another were at risk for the disease (8), and the third group had normal glucose tolerance (5).

All the participants took 20 mg of prednisone each morning for three days. Here is some of what the researchers observed:

  • Prednisone caused greater increases in glucose levels from midday to midnight in the type 2 diabetes group than in the other two groups
  • Levels of insulin declined after breakfast in the type 2 diabetes group, but there were no changes in the other two groups

In an earlier study (2004), researchers reported that 52 percent of patients who had neurologic diseases who were being treated with high doses of prednisolone for a mean of 6.9 weeks developed diabetes. The authors of this study emphasized the importance of monitoring glucose levels in neurologic patients who are taking high-dose steroids.

The bottom line
Given the increased risk of developing type 2 diabetes when using either low-dose or higher dose steroids, be sure to discuss alternatives to these medications if you are taking oral anti-inflammatory steroids for any reason or if your doctor wants to prescribe them.

Sources
Den Uyl D et al. Metabolic effects of high-dose prednisolone treatment in early rheumatoid arthritis: balance between diabetogenic effects and inflammation reduction. Arthritis and Rheumatism 2012 Mar; 64(3): 639-46
Iwamoto T et al. Steroid-induced diabetes mellitus and related risk factors in patients with neurologic disease. Pharmacotherapy 2004; 24(4)
Petersons CJ et al. Effects of low-dose prednisolone on hepatic and peripheral insulin sensitivity, insulin secretion, and abdominal adiposity in patients with inflammatory rheumatologic disease. Diabetes Care 2013 Sep; 36(9): 2822-29
Yuen KC et al. Twenty-four-hour profiles of plasma glucose, insulin, C-peptide and free fatty acid in subjects with varying degrees of glucose tolerance following short-term, medium-dose prednisone (20 mg/day) treatment: evidence for differing effects on insulin secretion and action. Clinical Endocrinology 2012 Aug; 77(2): 224-32

Photo: Flickr/jaykimdotnet

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