The Association Between Glucocorticoid Therapy and Diabetes

Patients with rheumatoid arthritis taking glucocorticoids in certain doses may have an increased risk of developing diabetes.

A recent study evaluated the risk of developing diabetes related to the dosage, duration, and timing of glucocorticoid therapy, which is prescribed to approximately half of patients with rheumatoid arthritis (RA).

Researchers examined the records of 21,962 patients with RA to compare the rates of new-onset diabetes in patients prescribed glucocorticoids with patients who did not receive the treatment, in a study published in Arthritis and Rheumatology.

The researchers found 1 new case of diabetes for every 150 to 200 patients treated annually with glucocorticoids. Within this group, the risk was only impacted by the dose within a 6-month period. Researchers found that a 5-mg increase of daily prednisolone increased the risk of developing diabetes by 25 to 30%. A dose of less than 5-mg was not associated with an increased risk compared with no treatment.

"Doctors treating people with arthritis have to make a decision how best to prescribe glucocorticoids by balancing the benefits against the risks. However, until now, no studies have considered how the risk changes with the dose and duration of treatment,” said lead author, Dr Will Dixon. "This research provides important evidence for doctors to make this decision."

Researchers also evaluated 12,657 records from the United States to verify their results. Body mass index, smoking status, and disease severity was also taken into account. However, researchers do not suggest that patients stop using glucocorticoids as treatment.

"This research shows that low doses of steroids (below 5mg/ day) do not increase the risk of diabetes. However, there is an increased risk of acquiring diabetes for people who use them for long periods or at high doses which can now be quantified,” Dr Dixon concluded.