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Cited by 314Adrenal Hormones and DisordersPharmacovigilance and Adverse Drug ReactionsDiabetes Treatment and Management

Glucocorticoids and the risk for initiation of hypoglycemic therapy

Gurwitz, Jerry H.·1994·Archives of Internal Medicine
DOI 10.1001/archinte.1994.00420010131015
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Abstract

PURPOSE: To quantify risk for the occurrence of hyperglycemia requiring initiation of hypoglycemic therapy in patients treated with oral glucocorticoids. PATIENTS AND METHODS: A case-control study of enrollees in the New Jersey Medicaid program 35 years of age or older. The 11,855 case patients had newly initiated treatment with a hypoglycemic agent (oral or insulin) between 1981 and 1990. The 11,855 controls represented a random sample of other Medicaid enrollees. RESULTS: In patients using oral glucocorticoids, the estimated relative risk for development of hyperglycemia requiring treatment was 2.23 (95% confidence interval, 1.92 to 2.59) as compared with nonusers. Risk increased with increasing average daily steroid dose, in hydrocortisone-equivalent milligrams; the odds ratio was 1.77 for 1 to 39 mg/d, 3.02 for 40 to 79 mg/d, 5.82 for 80 to 119 mg/d, and 10.34 for 120 mg/d or more. The estimated effects persisted after adjustment for a variety of potentially confounding demographic, health service utilization, and medication use variables. CONCLUSION: The findings of this population-based study quantify the risk of developing hyperglycemia requiring hypoglycemic therapy after oral glucocorticoid use. The magnitude of risk increases substantially with increasing glucocorticoid dose. These findings demonstrate the utility of large-scale health claims databases in defining the risk of important adverse drug effects.

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Crossref · 10.1001/archinte.1994.00420010131015

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  • In large retrospective case-control studies, low-dose GC treatment increased the odds for the initiation of blood-glucose lowering therapy by 63%.

    “In large retrospective case–control studies, it was demonstrated that low-dose GC treatment increased the odds for the initiation of blood-glucose lowering therapy by 63% [14]”

    From Low-dose glucocorticoid treatment affects multiple aspects of intermediary metabolism in healthy humans: a randomised controlled trial (2011) · cites this paper as [14]

  • Low-dose prednisolone-induced hepatic and adipose tissue insulin resistance provides supportive mechanisms for observations in large retrospective case-control studies that reported increased risk to develop diabetes and increased need to initiate blood-glucose lowering therapy during or following low-dose GC therapy.

    “Our data, demonstrating clear low-dose prednisolone-induced hepatic and adipose tissue insulin resistance, provide supportive mechanisms for observations made in large retrospective case–control studies that reported increased risk to develop diabetes [15] and increased need to initiate blood-glucose lowering therapy [14] during or following low-dose GC therapy.”

    From Low-dose glucocorticoid treatment affects multiple aspects of intermediary metabolism in healthy humans: a randomised controlled trial (2011) · cites this paper as [14]

  • There are reports of a dose-dependent increase in the risk of developing diabetes requiring hypoglycemic therapy.

    “GC-induced hyperglycemia or DM is nonetheless a common complication (-), and there are reports of a dose-dependent increase in the risk of developing DM requiring hypoglycemic therapy ().”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [194]

  • The risk of diabetes was greater in subjects with abdominal adiposity or genetic predisposition and in those taking higher doses of glucocorticoids for longer periods.

    “The risk of DM was greater in subjects with abdominal adiposity or a genetic predisposition to DM and in those taking higher doses of GCs and for longer periods (, -).”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [194]

  • In a case-control study, odds ratios for starting an oral hypoglycemic agent or insulin increased with hydrocortisone-equivalent dose: 1.77 for 1-39 mg/d, 3.02 for 40-79 mg/d, 5.82 for 80-119 mg/d, and 10.34 for at least 120 mg/d.

    “In a case-control study, the odds ratio of starting an oral hypoglycemic agent or insulin was . for patients receiving a hydrocortisone-equivalent dose of  to  mg/d, . for  to  mg/d, . for  to  mg/d, and . for $ mg/d ().”

    From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [194]

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Authors
Gurwitz, J. H.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Gurwitz, Jerry H.
ORCID
Gurwitz, Jerry H.
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
1994-01-10
Volume
154
Issue
1
Pages
97
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinte.1994.00420010131015
OpenAlex
W2091830937
Cited by
314
References
14
Citations by year
2026: 4 · 2025: 2 · 2024: 5 · 2023: 14 · 2022: 17 · 2021: 9 · 2020: 18 · 2019: 17 · 2018: 15 · 2017: 19 · 2016: 21 · 2015: 14 · 2014: 17 · 2013: 22 · 2012: 22
FWCI
2.93
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship@UMassChan (submittedVersion)
Funders
  • National Institutes of Health (1k08ag000510-01)
  • National Institute on Aging (AG-08812, K08 AG00510)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
oral corticosteroids, hyperglycemia, hypoglycemic therapy, insulin initiation, glucocorticoid dose, adverse drug reactions, Medicaid enrollees, diabetes risk
MeSH terms
Administration, Oral, Adult, Aged, Aged, 80 and over, Female, Glucocorticoids, Humans, Hypoglycemia, Male, Medicaid, Middle Aged, New Jersey, Risk, Statistics as Topic, United States, Case-Control Studies

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