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Twenty-four-hour profiles of plasma glucose, insulin, C-peptide and free fatty acid in subjects with varying degrees of glucose tolerance following short-term, medium-dose prednisone (20mg/day) treatment: evidence for differing effects on insulin secretion and action
Clinical Endocrinology, 07/17/2012
Clinical Article
Yuen KCJ et al. – Short–term, medium–dose prednisone treatment induces postprandial hyperglycaemia in type 2 diabetes (T2DM) and AR predominantly from midday to midnight because of suppression of insulin secretion followed by decreased insulin action that dissipates overnight. Effective treatment of prednisone–induced hyperglycaemia should target both rapid onset relative insulin deficiency and a less than 24–h total duration of effect.
Methods- An open-label cross-sectional interventional study.
- Three groups were prospectively studied: persons with type 2 diabetes (T2DM; n = 7), persons `at risk' for T2DM (AR; n = 8) and persons with normal glucose tolerance (NGT; n = 5).
- Before and after 3-day treatment with prednisone 20 mg each morning, subjects underwent 24-h frequent blood sampling.
- Eucaloric mixed meals were provided at 08:00, 12:00 and 18:00 h.
- Insulin/glucose ratio provided an estimate of β-cell response to meal stimuli.
- Prednisone induced greater increases in glucose levels from midday (P = 0.001) to midnight (P = 0.02) in the T2DM than the AR and NGT groups.
- In contrast, insulin (P = 0.03) and C-peptide (P = 0.04) levels decreased postbreakfast in the T2DM group, whereas no changes in the morning but higher C-peptide levels (P = 0.03) from midday to midnight were observed in the AR group.
- In the T2DM group, insulin/glucose ratio decreased postbreakfast (P = 0.04) and increased postdinner (P = 0.03).
- Fasting glucose, insulin and C-peptide levels were unchanged in all groups, and FFA levels modestly increased postdinner (P = 0.03) in the NGT group.
