Glucocorticoids administration would enhance blood glucose level and diabetes.

Medications known as glucocorticoids, such as prednisone and cortisone, are mainly used as anti-inflammatories or as anti-rejection drugs. They are prescribed, for example, for an arthritis attack or after an organ transplant.

One of their side effects is to increase blood glucose (sugar) since these drugs promote glucose production in the liver and reduce the sensitivity of the cells to insulin. Consequently, glucose accumulates in the blood and can cause a rise in blood sugar levels. The side-effects vary from person to person based on the prescribed dose of glucocorticoids, the way it is administered (cream, tablets or injection), and the length of time a person takes the drug.

Gluco-corticoids induced diabetes mellitus is a common and potentially harmful problem in clinical practice, affecting almost all medical specialties. However, its diagnosis and treatment are surprisingly undervalued by most healthcare professionals. The knowledge that hyperglycemia leads to longer hospital stays, delayed wound healing, increased infections, and higher mortality rates should encourage health-care providers to monitor its occurrence and to manage it appropriately. Similarly to T2DM in general, the principles of early detection and risk factor modification apply. Screening for GIDM should be considered in all patients (especially in those with risk factors) treated with medium to high doses of glucocorticoids. Diagnosing impaired fasting glucose or impaired glucose tolerance prior to the initiation of chronic glucocorticoids will better identify those who would benefit from glucocorticoid-sparing treatment, or if this is not an option, blood glucose monitoring while starting therapy. Together with, or after, lifestyle measures, hypoglycemic drugs with important insulin-sensitizing effects are indicated. Other oral hypoglycemic drugs or insulin therapy can be considered to be the drug of choice. Treatment, in most cases with insulin, should take into account the degree and pattern of hyperglycemia and the type, dose, and schedule of glucocorticoid used. Treatment should then be adjusted based on capillary glycemia and on changes in the dose of glucocorticoids. Moreover, it is essential to instruct the patient and/or the patient's family about how to perform these adjustments. Further investigation into the precise mechanism of glucocorticoid-induced insulin resistance will provide insights for future diabetes prevention efforts and targeted therapies.

Enjoy reading !

Zoheir

Glucocorticoids promote gluconeogenesis in the liver, but in skeletal muscle and white adipose tissue they decrease glucose uptake and utilization by counteracring insulin response thereby causing hyperglycemia and insulin resistance, and thus diabetes mellitus

Dr. Emmanuel Adebayo's explanation of metabolic processes leading to my views of enhancement of blood glucose and associated diabetes by glucocorticoid administration seems to be correct and ofcourse logical.

In hand dermatitis, integrity of epidermal barrier is compromised, so there is a chance of enhanced absorption after topical use of glucocorticoids though circulating levels might be very low. Again this absorbed amount will be metabolized. Chance of development of diabetes mellitus is a worth consideration. We should be more rational regarding topical use of glucocorticoids.

Please check

1. Suh S, Park MK. Glucocorticoid-Induced Diabetes Mellitus: An Important but Overlooked Problem. Endocrinol Metab (Seoul). 2017;32(2):180–189. doi:10.3803/EnM.2017.32.2.180

2. Hwang JL, Weiss RE. Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment. Diabetes Metab Res Rev. 2014;30(2):96–102. doi:10.1002/dmrr.2486

3. Miyawaki Y, Katsuyama T, Sada K-E, Hiramatsu S, Ohashi K, Morishita M, et al. (2017) A retrospective observational study of glucocorticoid-induced diabetes mellitus with IgA nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy. PLoS ONE 12(5): e0178018. https://doi.org/10.1371/journal.pone.0178018

4. Guido Di Dalmazi, Uberto Pagotto, Renato Pasquali, and Valentina Vicennati, “Glucocorticoids and Type 2 Diabetes: From Physiology to Pathology,” Journal of Nutrition and Metabolism, vol. 2012, Article ID 525093, 9 pages, 2012. https://doi.org/10.1155/2012/525093.

5. Lakhani OJ, Kumar S, Tripathi S, Desai M, Seth C. Comparison of two protocols in the management of glucocorticoid-induced hyperglycemia among hospitalized patients. Indian J Endocr Metab 2017;21:836-44

If it’s topical steroids, so the amount that absorbed is very little to cause damage to B cell so i don't think so.

I do believe strongly the positive implication of glucocorticoids with diabetes and hence glucocorticoid administration be avoided until necessary to raise glucose level through gluconeogenesis.

Good Day

Many Thanks.

My query was about topical glucocorticoid (clobetasol) very prolong (over 10 years) use hand dermatitis can cause Diabetes Mellitus?

Any body have any published work regarding local use of clobetasol and DM?

Regards.

For topical steroids , I fully endorse the views of Dr. Abbas Abd. In addition prolong usage of topical glucocorticoids would not cause Diabetes mellitus as the amount absorbed would be really small. Unfortunately to my knowledge , published papers pertaining to this are not available .

Current topical corticosteroid use was associated with an (unadjusted) 1.24-fold increased risk of diabetes (unadjusted OR 1.24; 95% CI 1.11, 1.40).

https://pubmed.ncbi.nlm.nih.gov › ...

Topical corticosteroids and the risk of diabetes mellitus: a nested case

Dear Mainul Haque . See the following useful RG links: Article Glucocorticoids and Type 2 Diabetes: From Physiology to Pathology

Article Glucocorticoids and Diabetes

Article Glucocorticoid-Induced Diabetes Mellitus: An Important but O...

Kindly see also the following useful RG links: Article Glucocorticoid-Induced Diabetes Mellitus: An Important but O...

Article Glucocorticoid-induced Diabetic Ketoacidosis in Acute Rheumatic Fever

Article Effect of short-term prednisone on beta-cell function in sub...

https://www.saem.org.ar/departamentos/departamento-neuroendocrinologia/manejo-de-pacientes-con-coticoterapia.pdf

https://www.nature.com/articles/s41574-022-00683-6