Glycemic control in children receiving glucocorticoid therapy

Hyperglycemia is a well-known side effect of glucocorticoid (GC) therapy. GC treatment can lead to steroid diabetes mellitus (DM) manifestation. Glycemic control is essential for patients receiving GC. Three clinical cases of carbohydrate metabolism impairment (hyperglycemia) in children receiving GC needing glycemic control were described. In the 1^st case transient fasting hyperglycemia up to 8.3 mmol/l (while normal data after meals) was detected during 3 days after start of GC pulse-therapy of bronchial asthma. Normalization of glycaemia was evident since the 4^th day in spite of GC therapy continuing for 6 days. In the 2^nd case transient hyperglycemia while pulse-therapy of juvenile arthritis with systemic onset was detected on the 3^rd day (7.25 mmol/l), GC in tablets was added, pulse-therapy with gradually dose reduction continued 9 days else. Hyperglycemia (up to 11.7 mmol/l) persisted for 4 days, then glycaemia normalization was detected in spite of continuing GC therapy (50 mg or 0.7 mg/kg). In the 3rd case steroid DM in a patient with juvenile systemic scleroderma, familial history of DM type 2, and obesity manifested after 2 months of treatment with GC tablets (35 mg or 0.6 mg/kg), metformin was prescribed. While reduction of GC dose trend to glycaemia normalization was seen. In 4 months after cessation of GC impaired glucose tolerance and insulin resistance were diagnosed.

Glycemic control is essential for patients receiving GC. Hyperglycemia while receiving GC can be both transient or persistent. Risk of steroid DM is higher in cases of family history of DM type 2, obesity, high doses, and prolonged GC treatment. In patients at-risk of DM type 2 impairment of carbohydrate metabolism can persist after cessation of GC; this needs repeated examination.

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