Glucocorticoid-induced diabetes in patients with metastatic spinal cord compression
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Glucocorticoid-induced diabetes in patients with metastatic spinal cord compression. / Schultz, Helga; Engelholm, Svend Aage; Harder, Eva; Pedersen-Bjergaard, Ulrik; Kristensen, Peter Lommer.
I: Endocrine Connections, Bind 7, Nr. 5, 2018, s. 719-726.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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T1 - Glucocorticoid-induced diabetes in patients with metastatic spinal cord compression
AU - Schultz, Helga
AU - Engelholm, Svend Aage
AU - Harder, Eva
AU - Pedersen-Bjergaard, Ulrik
AU - Kristensen, Peter Lommer
N1 - © 2018 The authors.
PY - 2018
Y1 - 2018
N2 - BACKGROUND: The risk of developing diabetes mellitus (DM) during treatment with high-dose glucocorticoids is unknown and monitoring of glucose is random in many settings.OBJECTIVE: To determine incidence of and risk factors for induction of DM during high-dose glucocorticoid therapy of metastatic spinal cord compression (MSCC) in patients referred to radiotherapy. Furthermore, to describe the time course of development of DM.SUBJECTS AND METHODS: 140 patients were recruited (131 were included in the analysis) with MSCC receiving high-dose glucocorticoid ≥100 mg prednisolone per day were included in a prospective, observational cohort study. The primary endpoint was development of DM defined by two or more plasma glucose values ≥11.1 mmol/L. Plasma glucose was monitored on a daily basis for 12 days during radiotherapy.RESULTS: Fifty-six of the patients (43%; 95% CI 35-52%) were diagnosed with DM based on plasma glucose measurements during the study period. Sixteen patients, 12% (95% CI 6-18%), were treated with insulin. At multivariate analysis, only high baseline HbA1c predicted the development of insulin-treated DM. An HbA1c-value <39 mmol/mol was associated with a negative predictive value of 96% for not developing DM needing treatment with insulin. The diagnosis of diabetes with need for insulin treatment was made within 7 days in 14 of the 16 (88%; 95% CI 72-100%) patients.CONCLUSION: The risk of developing DM during treatment with high-dose glucocorticoids in patients with MSCC referred to radiotherapy is high in the first treatment week. Only referral HbA1c predicts the development of DM.
AB - BACKGROUND: The risk of developing diabetes mellitus (DM) during treatment with high-dose glucocorticoids is unknown and monitoring of glucose is random in many settings.OBJECTIVE: To determine incidence of and risk factors for induction of DM during high-dose glucocorticoid therapy of metastatic spinal cord compression (MSCC) in patients referred to radiotherapy. Furthermore, to describe the time course of development of DM.SUBJECTS AND METHODS: 140 patients were recruited (131 were included in the analysis) with MSCC receiving high-dose glucocorticoid ≥100 mg prednisolone per day were included in a prospective, observational cohort study. The primary endpoint was development of DM defined by two or more plasma glucose values ≥11.1 mmol/L. Plasma glucose was monitored on a daily basis for 12 days during radiotherapy.RESULTS: Fifty-six of the patients (43%; 95% CI 35-52%) were diagnosed with DM based on plasma glucose measurements during the study period. Sixteen patients, 12% (95% CI 6-18%), were treated with insulin. At multivariate analysis, only high baseline HbA1c predicted the development of insulin-treated DM. An HbA1c-value <39 mmol/mol was associated with a negative predictive value of 96% for not developing DM needing treatment with insulin. The diagnosis of diabetes with need for insulin treatment was made within 7 days in 14 of the 16 (88%; 95% CI 72-100%) patients.CONCLUSION: The risk of developing DM during treatment with high-dose glucocorticoids in patients with MSCC referred to radiotherapy is high in the first treatment week. Only referral HbA1c predicts the development of DM.
U2 - 10.1530/EC-18-0088
DO - 10.1530/EC-18-0088
M3 - Journal article
C2 - 29669805
VL - 7
SP - 719
EP - 726
JO - Endocrine Connections
JF - Endocrine Connections
SN - 2049-3614
IS - 5
ER -
ID: 213963283