Management in multimorbidity: glucocorticoid-induced hyperglycemia and diabetes in rheumatic diseases

Glucocorticoids (GC) are drugs with an important antiinflammatory and immunosuppressive effect, being recommended in treating autoimmune diseases, but which have a series of metabolic side effects, including diabetes. The purpose of the research is to highlight the possibilities of monitoring and treating hyperglycemia and diabetes mellitus (DM) induced by glucocorticoids in patients with rheumatic diseases to optimize the management of these patients. A literature review on the management of glucocorticoid-induced hyperglycemia and diabetes was performed. The databases searched were PubMed, Medline, Web of Science. The MeSh terms were „corticosteroid-induced hyperglycemia” OR „corticosteroidinduced diabetes” AND (rheumatic diseases). 26 sources were identified and analyzed. American and British Diabetic Society guidelines for the diagnosis and management of glucocorticoid-induced hyperglycemia and diabetes aim largely at hospitalized patients, and subsequent outpatient follow-up is inconclusive. At the initiation of GC therapy, it is recommended to assess the basal blood glucose in hospitalized people with DM, four times a day postprandial, and in patients who are not known to have diabetes - once a day. With the development of steroid-induced DM, oral antidiabetics will be recommended, and in cases when patients present significant hyperglycemia in association with signs of diabetic ketoacidosis or hyperosmolar hyperglycemic state, the recommendations of the international guidelines are to initiate insulin. After stopping the administration of GC, the blood sugar will be constantly and repeatedly monitored, together with the review of the hypoglycemic therapy and the achievement of normoglycemia during 3 months, and if it persists, the blood sugar will be monitored after 3 months, together with the performance of the oral glucose tolerance test or HbA1c.