Effects of Low-Dose Prednisolone on Hepatic and Peripheral Insulin Sensitivity, Insulin Secretion, and Abdominal Adiposity in Patients With Inflammatory Rheumatologic Disease

  1. Morton G. Burt, PHD1,2
  1. 1Faculty of Health Sciences, Flinders University, Adelaide, Australia
  2. 2Southern Adelaide Diabetes and Endocrine Services, Repatriation General Hospital, Adelaide, Australia
  3. 3Diabetes and Obesity Research Program, Garvan Institute of Medical Research, Sydney, Australia
  4. 4School of Health Sciences, University of Wollongong, Wollongong, Australia
  5. 5Bioanalytical Mass Spectrometry Facility and School of Medical Sciences, University of New South Wales, Sydney, Australia
  6. 6Department of Rheumatology, Repatriation General Hospital, Adelaide, Australia
  7. 7Department of Endocrinology, St. Vincent’s Hospital, Sydney, Australia
  8. 8Discipline of Medicine, University of Adelaide, Adelaide, Australia
  1. Corresponding author: Carolyn J. Petersons, carolynpetersons{at}yahoo.com.au

Abstract

OBJECTIVES The metabolic effects of low-dose prednisolone and optimal management of glucocorticoid-induced diabetes are poorly characterized. The aims were to investigate the acute effects of low-dose prednisolone on carbohydrate metabolism and whether long-term low-dose prednisolone administration increases visceral adiposity, amplifying metabolic perturbations.

RESEARCH DESIGN AND METHODS Subjects with inflammatory rheumatologic disease without diabetes mellitus were recruited. Nine subjects (age, 59 ± 11 years) not using oral glucocorticoids were studied before and after a 7- to 10-day course of oral prednisolone 6 mg daily. Baseline data were compared with 12 subjects (age, 61 ± 8 years) using continuous long-term prednisolone (6.3 ± 2.2 mg/day). Basal endogenous glucose production (EGP) was estimated by 6,6-2H2 glucose infusion, insulin sensitivity was estimated by two-step hyperinsulinemic-euglycemic clamp, insulin secretion was estimated by intravenous glucose tolerance test, and adipose tissue areas were estimated by computed tomography.

RESULTS Prednisolone acutely increased basal EGP (2.44 ± 0.46 to 2.65 ± 0.35 mg/min/kg; P = 0.05) and reduced insulin suppression of EGP (79 ± 7 to 67 ± 14%; P = 0.03), peripheral glucose disposal (8.2 ± 2.4 to 7.0 ± 1.6 mg/kg/min; P = 0.01), and first-phase (5.9 ± 2.0 to 3.9 ± 1.6 mU/mmol; P = 0.01) and second-phase (4.6 ± 1.7 to 3.6 ± 1.4 mU/mmol; P = 0.02) insulin secretion. Long-term prednisolone users had attenuated insulin suppression of EGP (66 ± 14 vs. 79 ± 7%; P = 0.03) and nonoxidative glucose disposal (44 ± 24 vs. 62 ± 8%; P = 0.02) compared with nonglucocorticoid users, whereas basal EGP, insulin secretion, and adipose tissue areas were not significantly different.

CONCLUSION Low-dose prednisolone acutely perturbs all aspects of carbohydrate metabolism. Long-term low-dose prednisolone induces hepatic insulin resistance and reduces peripheral nonoxidative glucose disposal. We conclude that hepatic and peripheral insulin sensitivity should be targeted by glucose-lowering therapy for glucocorticoid-induced diabetes.

  • Received December 17, 2012.
  • Accepted March 1, 2013.

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  1. Diabetes Care
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