Intravenous pulse methylprednisolone therapy in eye disease: effect on glucose tolerance

Abstract Purpose To determine which subjects need close glycemic monitoring during intravenous pulse methylprednisolone therapy for eye disease. Design Retrospective study in a national eye center. Participants Two hundred twenty-four subjects who received over a one-year period 250 to 1000 mg daily intravenous methylprednisolone over 3 consecutive days for ophthalmologic conditions. Methods Blood glucose monitoring during pulse methylprednisolone therapy followed a protocol written in 1995. We analyzed the effects of 3 days of pulse methylprednisolone therapy on glucose tolerance and their clinical implications in diabetic and nondiabetic subjects treated during 2000. Main outcome measure Serial morning fasting blood glucose; that is, before the first pulse and the day after each pulse, blood glucose self-monitoring for diabetic subjects and specific hypoglycemic drug interventions were recorded. Results All subjects showed a median 50% increase in fasting glucose after the first steroid infusion, without a significant difference between diabetic and nondiabetic subjects. Thereafter, the 196 nondiabetic subjects showed spontaneous decreases of their fasting glucose toward baseline values despite the following infusions, whereas the 28 diabetic subjects (all type 2) demonstrated further increases of blood glucose, and 7 received rapid-release insulin to maintain blood glucose lower than 14 mmol/l. All 5 diabetic subjects with baseline glycosylated hemoglobin ≥ 8.3% required insulin therapy. Conclusions Close glycemic monitoring seems necessary only for subjects with diabetes during intravenous pulse methylprednisolone therapy for ophthalmologic conditions. The probability of subjects with type 2 diabetes requiring insulin during this therapy does seem to be positively related to the level of pretreatment glycosylated hemoglobin.