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AB1204-HPR Evaluation of carbohydrate metabolism in rheumatologic patients after pulse therapy with glucocorticoids

Background Chronic inflammation – the crucial pathogenic mechanism of rheumatoid arthritis is the main cause of accelerated atherosclerosis, insulin resistance and well-known consequences related to it. The conservative treatment of rheumatoid arthritis may provide a significant influence on glucose metabolism. When the duration of rheumatic diseases of administration and dosage of glucocorticoids (GC) are significant predictors of the development of impaired glucose tolerance and diabetes mellitus. Objectives To study the effect of pulse-therapy (PT) of the GC on the violation of carbohydrate metabolism in patients with rheumatic diseases Methods The study included 35 patients (7 men, 18 women) with a variety of rheumatic diseases (systemic lupus erythematosus - 23, systemic vasculitis - 12) between the ages of 18 to 68 years (mean age 42,3±14,43 years) and duration of disease from 6 months to 12 years (mean 3,55±3,36 years). Pulse-therapy of GK included intravenous prednisolone 600–1000 mg per day for 3 consecutive days (course dose of 1800–3000 mg). Oral glucose tolerance test (OGTT) was performed after the course.The first group included patients with a normal result of OGTT (glucose concentration of <7.8 mmol/L at 2 hours after taking 75 g of glucose). There were 23 patients in the first group at the age of 18 to 54 years (mean age 38.0±2.8 years). Patients of the second group level had OGTT was>7.8 mmol/L. This group included 12 people aged from 44 to 61 years (mean age 52,6±8,4 years). All patients underwent the measurement of blood glucose levels prior to PT, 2, 4, 6, 10, 24, 48 and 72 hours and after the PT Results All patients included in the study, after the PT session there was an increase in blood glucose levels with a peak at 4 hours after the start of administration - 12.2±0.82 in the first group, in the second to 21.95±0.25 mmol/l (p<0,05). Normalization of glucose levels in the first group of patients occurred within 1.75±0.18 days (1 to 3), whereas in the second - for 5,0±1,0 (3 to 5; p<0,05). During the OGTT the mean fasting blood glucose levels in patients with the first group was 4.49±0.12 mmol/l, and the second - 5,85±0,35 (p<0,05), after 2 hours - 6.0±0.21 and 10.0±1.5 mmol/l, respectively (p<0,05). Conclusions Application PT of GC in rheumatic patients causes blood glucose levels to change values, indicating the development of impaired glucose tolerance. Predictors of disorders of carbohydrate metabolism in these patients are high levels of glycemia during the PT more continuous glucose normalization indices after the course PT GC. References Alekseeva EI. Pulse therapy with glucocorticoids of systemic manifestations of rheumatoid arthritis in children. Questions of modern times. Pediatrician 2005;4(1)9–14. Lebets IS, Tolmacheva SR, Shevchenko NS. Modern approaches to the treatment of systemic lupus erythematosus in adolescents. Wedge. Pediatrician 2012;6:91–94. Omelchenko LI, Nikolaenko VB. Some aspects of improving glucocorticoid therapy in rheumatic diseases in children. Ukr. Rheumatology 2010;1:44–49. Disclosure of Interest None declared