Optimizing the Treatment of Steroid-Induced Hyperglycemia

Ann Pharmacother. 2018 Jan;52(1):86-90. doi: 10.1177/1060028017728297. Epub 2017 Aug 24.


Objective: To review therapeutic strategies for the management of patients with steroid-induced hyperglycemia.

Data sources: A literature search of MEDLINE/PubMed (1990 to June 2017) was conducted using the search terms steroid, glucocorticoid, corticosteroid, hyperglycemia, and diabetes as well via review of literature citations.

Study selection and data extraction: Relevant clinical trials and case studies focusing on pharmacological interventions in humans were reviewed for inclusion. Articles discussing islet cell transplant were excluded.

Data synthesis: Hyperglycemia is a predictable adverse effect of glucocorticoid therapy, which is associated with negative outcomes, including an odds ratio of 1.36 for developing new-onset diabetes. A variety of strategies have been utilized for managing patients who are at risk of complications caused by steroid-induced hyperglycemia. Agents such as sulfonylureas, thiazolidinediones, meglitinides, metformin, dipeptidyl peptidase 4 (DPP-4) inhibitors, glucagon-like peptidase-1 agonists, and insulin have been evaluated in case studies and small clinical trials with varying degrees of success.

Conclusions: Since there are limited clinical data available to guide therapy, strategies that minimize the risk of adverse effects should be selected for the management of steroid-induced hyperglycemia. Therapies that may be safe and effective given current information include DPP-4 inhibitors, metformin, and weight-based neutral protamine Hagedorn insulin.

Keywords: antihyperglycemics; corticosteroids; diabetes; endocrinology; insulin; type 2.

Publication types

  • Review

MeSH terms

  • Diabetes Mellitus, Type 2 / prevention & control
  • Dipeptidyl-Peptidase IV Inhibitors / therapeutic use
  • Glucocorticoids / adverse effects*
  • Humans
  • Hyperglycemia / chemically induced
  • Hyperglycemia / drug therapy*
  • Hypoglycemic Agents / therapeutic use*
  • Sulfonylurea Compounds / therapeutic use


  • Dipeptidyl-Peptidase IV Inhibitors
  • Glucocorticoids
  • Hypoglycemic Agents
  • Sulfonylurea Compounds