Glucose disturbances in non-diabetic patients receiving acute treatment with methylprednisolone pulses

objective: methylprednisolone pulses are used in a variety of disease conditions, both for acute and chronic therapy. although well tolerated, they increase glucose levels in both non-diabetic and diabetic patients. they may also be considered a significant risk for acute metabolic alterations. the purpose of this report is to determine the metabolic changes in blood glucose levels in non-diabetic patients receiving methylprednisolone pulses and identify the presence of predictive factors for its development. methods: observational, prospective study in 50 non-diabetic patients receiving 1 g intravenous methylprednisolone pulses for three consecutive days as an indication for diverse autoimmune disorders. demographic, anthropometric, and metabolic variables were analyzed, and glucose, insulin and c-peptide levels after each steroid pulse were identified. different variables and the magnitude of hyperglycemia were analyzed using pearson's correlation. results: 50 patients were included, predominantly women (66%, n = 33). the average age was 41 ± 14 years with a bmi of 26 ± 3 kg/m2. baseline glucose was 83 ± 10 mg/dl. after each steroid pulse, glucose increased to 140 ± 28, 160 ± 38 and 183 ± 44, respectively (p < 0.001). c-peptide and insulin concentrations increased significantly (p < 0.001). the prevalence of fasting hyperglycemia after each pulse was 68%, 94% and 98%, respectively. we found no correlation between the magnitude of hyperglycemia and the studied variables. conclusion: methylprednisolone pulses produced significant increases in fasting glucose in most patients without diabetes. further studies are needed to define its role in long-term consequences.