roid treatment. Statistical analysis Characteristics Number of subjects Demographic characteristics Age, yr (median, range) Male sex (%) Body mass index (kg/m2) Current or ex-smoker Pack-years Respiratory diseases requiring steroid treatment Idiopathic interstitial pneumonitis Endobronchial tuberculosis Sarcoidosis Hypersensitive pneumonitis Comorbidities Hypertension Hyperlipidemia Chronic kidney disease Chronic liver disease Malignancy Initial laboratory findings Random glucose (mg/dL) Creatinine (mg/dL) Cholesterol (mg/dL) Use of glucocorticoid (median, range) Total dose* (mg) Daily dose (mg) Total duration (days) *Equivalent dose of prednisolone. DOI: 10.3346/jkms.2011.26.2.264 Kim SY, et al. • Steroid-induced Diabetes ed with glucocorticoid included idiopathic interstitial pneumo- and the t-test to compare continuous variables between patients nia, endobronchial tuberculosis, sarcoidosis, and hypersensi- with and without S-DM. The variables analyzed included age, tivity pneumonitis. Patients with asthma and chronic obstruc- sex, body mass index (BMI), underlying lung diseases, daily and tive pulmonary disease (COPD) were not included, not only cumulative dose of steroid, duration of treatment, and initial because they frequently used inhaled steroid, but also because random serum glucose level. To identify predictors of S-DM, their use of systemic steroid was usually short term. multiple logistic regression models were constructed that in- Patients with respiratory diseases treated with systemic gluco- cluded any variables with P < 0.10. Statistical significance was corticoid exceeding a prednisolone-equivalent dose of 20 mg/ considered if P < 0.05. All statistical analyses were performed day for at least for 4 weeks were included in the analysis. Patients using SPSS® (Version 12.0, Chicago, IL, USA). with pre-existing diabetes or an initial random glucose level ex- ceeding 200 mg/dL before initiating steroid therapy were exclud- Ethics statement ed. We also excluded patients who were treated with steroid for The study protocol was approved by the institutional review boards other than lung diseases, such as malignancy, rheumatoid ar- of the Seoul National University Hospital (H-0906-059-284), thritis, transplantation, and nephrotic syndrome. Seoul National University Bundang Hospital (B-1001-092-103), The demographic characteristics, clinical findings, and labo- and Seoul National University Boramae Hospital (06-2010-4). ratory results were obtained from a retrospective review of the medical records. In addition, detailed information on the use of glucocorticoid (daily dose, duration of treatment, and cumula- tive dose) was collected. RESULTS Incidence of steroid-induced diabetes Steroid-induced DM (S-DM) was defined as a fasting glucose The analysis included 231 patients with respiratory diseases who concentration above 126 mg/dL or a random glucose concen- started taking systemic glucocorticoid during the study period. tration exceeding 200 mg/dL at least twice after beginning ste- Their median age was 55 yr (range 22–85 yr), and 139 were fe- The chi-squared test was used to compare categorical variables, cluded idiopathic interstitial pneumonia (125 patients), endo- Table 1. Baseline demographic and clinical characteristics of the patients with respiratory diseases treated with steroid male (60.2%). The baseline clinical characteristics and labora- tory findings of the study population are summarized in Table 1. Respiratory diseases requiring glucocorticoid treatment in- All patients 231 55 (22-85) 92 (39.8%) 23.2 ± 3.7 80 (34.6%) 10.7 ± 20.2 125 (54.1%) 60 (26.0%) 43 (18.6%) 3 (1.3%) 35 (15.4%) 12 (5.3%) 11 (4.8%) 3 (1.3%) 10 (4.4%) 101 (59-198) 0.9 (0.4-1.5) 179 (88-331) 4,965 (560-32,585) 21.4 (6-64.4) 193 (28-1,869) Patients with steroid-induced DM 34 65 (50-81) 18 (52.9%) 23.6 ± 3.2 19 (55.9%) 23.1 ± 25.5 27 (79.4%) 2 (5.9%) 5 (14.7%) 0 8 (25.0%) 4 (12.5%) 1 (3.0%) 0 2 (6.5%) 108 (76-190) 0.9 (0.6-1.4) 186 (121-283) 5,454 (940-23,590) 24.6 (7-58.9) 168 (33-1,408) Patients without steroid-induced DM 197 53 (22-85) 74 (37.6%) 22.9 ± 3.8 61 (31 %) 8.5 ± 18.4 98 (49.7%) 58 (29.4%) 38 (19.3%) 3 (1.5%) 27 (13.8%) 8 (4.1%) 10 (5.1%) 3 (1.5%) 8 (4.1%) 100 (59-198) 0.9 (0.4-1.5) 178 (88-331) 4,880 (560-32,585) 20.4 (6-64.4) 198 (28-1,869) P value < 0.001 0.09 0.53 0.005 0.004 0.001 0.004 0.53 > 0.99 0.12 0.07 > 0.99 > 0.99 0.63 0.12 0.71 0.22 0.60 0.25 0.91 http://jkms.org 265