ORIGINAL ARTICLE Respiratory Diseases DOI: 10.3346/jkms.2011.26.2.264 • J Korean Med Sci 2011; 26: 264-267 Incidence and Risk Factors of Steroid-induced Diabetes in Patients with Respiratory Disease Seo Yun Kim1, Chul-Gyu Yoo1, Chun Taeg Lee2, Hee Soon Chung3, Young Whan Kim1, Sung Koo Han1, Young-Soo Shim1, and Jae-Joon Yim1 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, Seoul; 2Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University Bundang Hospital, Seongnam; 3Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea Received: 13 August 2010 Accepted: 26 October 2010 Address for Correspondence: Jae-Joon Yim, MD Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute of Medical Research Center, Seoul National University College of Medicine, 101 Daehang-no, Jongno-gu, Seoul 110-744, Korea Tel: +82.2-2072-2059, Fax: +82.2-762-9662 E-mail: yimjj@snu.ac.kr Glucocorticoids are effective for treating several respiratory diseases. However, they can cause hyperglycemia. This study determined the incidence and risk factors of steroid- induced diabetes mellitus (S-DM) in patients treated with glucocorticoid for respiratory diseases. A retrospective study examined patients with respiratory diseases treated with a prednisolone-equivalent glucocorticoid dose exceeding 20 mg/day for at least 4 weeks between January 2003 and December 2008. Patients whose initial random glucose level exceeded 200 mg/dL or who had pre-existing diabetes were excluded. S-DM was defined as a fasting glucose concentration exceeding 126 mg/dL or a random glucose concentration exceeding 200 mg/dL at least twice after beginning steroid treatment. A total of 231 patients with respiratory diseases met the inclusion criteria. Their median age was 55 yr, and 139 were female. The median cumulative prednisolone-equivalent glucocorticoid dose was 4,965 mg, and the median duration of steroid treatment was 193 days. S-DM was diagnosed in 34 (14.7%) of 231 patients. Multivariate logistic regression identified older age (odds ratio 1.05, 95% confidence interval 1.02-1.09) as a risk factor for S-DM. S-DM is frequent among patients with respiratory diseases treated with glucocorticoid. Clinicians should be aware of the possibility of S-DM, especially among elderly patients. Key Words: Diabetes; Glucocorticoids; Hyperglycemia; Respiration Disorders; Steroids INTRODUCTION Since the introduction of glucocorticoids in the 1950s, they have played a pivotal role in the treatment of various inflammatory diseases, including respiratory diseases. As they decrease inflam- mation and minimize tissue damage (1), glucocorticoids have been used widely to treat idiopathic interstitial pneumonia, chronic obstructive pulmonary disorders, endobronchial tu- berculosis, sarcoidosis, hypersensitivity pneumonitis, and other respiratory diseases. However, glucocorticoids have various adverse effects. They can cause glaucoma, fluid retention, increased blood pressure, increased blood sugar, menstrual irregularities, weight gain, stomach pain, insomnia, and infection. Impaired glucose me- tabolism is one of the commonest adverse effects. Glucocorti- coids not only exacerbate hyperglycemia in patients with known diabetes mellitus (DM), but also cause DM in patients without documented hyperglycemia before the initiation of glucocorti- coid therapy (2). The hyperglycemic condition is transient in many cases, but some patients may develop polydipsia, polyuria, and repeated infections. Especially in the elderly, there is a risk of precipitating hyperglycemic hyperosmolar states, including coma. In the long-term, the overall burden of repeated increas- es in blood glucose may increase cardiovascular risk (3, 4) and the risk of microvascular complications (5). This study examined the incidence and clinical risk factors of steroid-induced DM in patients treated with glucocorticoid ther- apy for various respiratory diseases. MATERIALS AND METHODS Patients We included adult patients (age > 20 yr) with respiratory diseases who were newly started on glucocorticoids from January 2003 through December 2008 at three hospitals affiliated with Seoul National University, Korea: Seoul National University Hospital, Seoul National University Bundang Hospital, and Seoul Nation- al University Boramae Hospital. The respiratory diseases treat- © 2011 The Korean Academy of Medical Sciences. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. pISSN 1011-8934 eISSN 1598-6357