Background: Steroid induced diabetes (SDM) has been known for a long time, but its pathophysiological mechanisms as well as its predisposing factors remain unknown.
Methods: In order to investigate the different factors related to the development of steroid diabetes (SDM) in patients with rheumatic diseases, we studied 27 patients with SDM, and 27 age- and sex-matched controls who also received therapy with glucocorticoids. In every case, family history of DM, body mass index, associated treatment, steroid dose and treatment duration were studied; fasting serum insulin, "C" peptide, growth hormone and glucagon levels were measured.
Results: All of the patients received prednisone. Cumulated prednisone dose was the only factor significantly associated with the development of SDM. Patients with SDM had a cumulated dose of 26.6 +/- 28 g (M +/- SD), while the control group received 11.6 +/- 11 g (p < 0.02) (odds ratio, 6.35). Serum insulin levels were not significantly different, but insulin/glucose ratio was lower in SDM (0.104 +/- 0.05) than in the control group (0.163 +/- 0.07) (p < 0.05).
Conclusions: These findings suggest that high cumulated prednisone dose may induce DM regardless of another hereditary or personal predisposing factor.