The prevalence and management of hyperglycaemia in patients with rheumatoid arthritis on corticosteroid therapy
Abstract
BACKGROUND AND AIMS: Corticosteroids are commonly used in the treatment of RA. Hyperglycaemia resulting from corticosteroid use can lead to problems, particularly in those with impaired glucose tolerance and diabetes mellitus. We have examined how rheumatology clinics monitored and managed hyperglycaemia at base line and during treatment of patients with rheumatoid arthritis on corticosteroids. METHODS: Case notes of 102 patients with established RA, on long-term steroids were reviewed. We recorded a) blood glucose level at base line and whilst on steroids b) when and whether hyperglycaemia was addressed. RESULTS: There were 24 males and 78 females, with mean age of 62 +/- 15 years. Patients were on corticosteroids for a median duration of 24 months. Seventy-five per cent of patients were treated with oral prednisolone, the rest, except one patient on deflazacort, were on methylprednisolone. Blood glucose was measured at baseline in 97% of patients with 37% and 38% being monitored at three months and six months respectively and 36% annually thereafter. Nine patients (8.8%) developed diabetes mellitus during treatment, but one patient was detected and managed. There were six patients with existing diabetes mellitus in whom glycaemic control worsened between three to six months, but only one patient had treatment adjusted. CONCLUSIONS AND RECOMMENDATIONS: Physicians need to be aware that corticosteroids can increase blood glucose, worsen pre-existing diabetes and predispose to diabetes mellitus. Patients on long-term corticosteroids should be monitored at regular intervals as corticosteroid induced glycaemic excursions may lead to the development of diabetes mellitus and increased coronary risk.
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Nearly 9% of patients with rheumatoid arthritis developed diabetes within 2 years of starting glucocorticoid treatment.
“Nearly % of patients with rheumatoid arthritis developed DM within years of starting GC treatment ().”
From Glucose Metabolism Abnormalities in Cushing Syndrome: From Molecular Basis to Clinical Management (2017) · cites this paper as [192]
Glucocorticoid-induced hyperglycemia or diabetes is a common complication.
“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 [192]
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- Authors
- Panthakalam, S., Bhatnagar, D., & Klimiuk, P.
- Affiliations
- Royal Oldham Hospital (GB)
- Corresponding author
- Bhatnagar, D
- Venue
- Scottish Medical Journal
- Publisher
- SAGE Publications
- Published
- 2004-11
- Volume
- 49
- Issue
- 4
- Pages
- 139-141
- ISSN
- 0036-9330 (ISSN-L)
- 2045-6441
- OpenAlex
- W2114744470
- Cited by
- 69
- References
- 20
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 1 · 2023: 4 · 2022: 2 · 2021: 3 · 2020: 3 · 2019: 2 · 2018: 2 · 2017: 7 · 2016: 4 · 2015: 6 · 2014: 5 · 2013: 6 · 2012: 4
- FWCI
- 0.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Scottish Medical Journal (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- rheumatoid arthritis, prednisolone, methylprednisolone, diabetes mellitus, impaired glucose tolerance, glycaemic monitoring, deflazacort, coronary heart disease risk
- MeSH terms
- Adrenal Cortex Hormones, Adult, Aged, Aged, 80 and over, Arthritis, Rheumatoid, Diabetes Mellitus, Female, Humans, Hyperglycemia, Male, Methylprednisolone, Middle Aged, Prednisolone, Retrospective Studies, Prevalence
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