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The effect of steroid pulse therapy on carbohydrate metabolism in multiple myeloma patients: a randomized crossover observational clinical study

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Abstract

Background

Hyperglycemia is a common, but not well-characterized side effect of glucocorticoid treatment.

Aim

To study the effect of pulse dexamethasone treatment on carbohydrate metabolism among multiple myeloma patients.

Material/subjects and methods

A randomized crossover observational study in a teaching hospital with nine myeloma patients (one male, two with known type 2 diabetes (KDM), mean age 69.0 ± 6.7 years) were investigated using a standard 75 g Oral Glucose Tolerance Test (patients without KDM) and a 3-day continuous glucose monitoring (CGM—all patients) during and between dexamethasone cycles.

Results

During dexamethasone treatment patients had elevated 2-h postload glucose (12.8 ± 4.7 vs. 8.7 ± 3.2 mmol/L, P = 0.024) but similar fasting glucose (6.3 ± 1.4 vs. 5.1 ± 0.5 mmol/L, P = 0.112). Estimated hourly mean interstitial glucose values based on linear mixed models showed an increase of 0.03 [SE 0.01] mmol/L per hour from 5.0 [0.4] in patients without KDM and followed a quadratic curve from 5.0 [0.4] mmol/L at midnight to 7.5 [0.5] mmol/L at 12:00 h in patients with KDM during control periods. During dexamethasone treatment glucose was similar to control periods between 02:00 and 12:00 h in the non-KDM group, where they followed a cubic trajectory from 5.3 [0.4] mmol/L at 04:00 h to 7.3 [0.4] mmol/L at 18:00 h. In contrast, interstitial glucose was increased by at least 7.9 [0.3] mmol/L throughout the day in KDM patients during dexamethasone treatment and increased from 13.6 [0.5] mmol/L at midnight to 17.5 [0.5] mmol/L at 17:00 h.

Conclusions

During pulse steroid therapy of myeloma patients without KDM afternoon and evening glucose measurements may be the optimal tools to characterize glucose metabolism.

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Abbreviations

CGM:

Continuous glucose monitoring

CGMS:

Continuous glucose monitoring system

Dex:

Dexamethasone

IFG:

Impaired fasting glucose

IGT:

Impaired glucose tolerance

ISS:

International staging system

KDM:

Known diabetes mellitus

OGTT:

Oral glucose tolerance test

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Acknowledgments

This study was supported by the Hungarian Diabetes Association. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. AGT is supported by the European Union and the State of Hungary, co-financed by the European Social Fund in the framework of TÁMOP 4.2.4. A/-11-1-2012-0001 ‘National Excellence Program’. O.V. and A.G.T. researched the data, wrote the manuscript, contributed to discussion, and reviewed/edited the manuscript. A.W, J.D., G.T, and I.M. researched the data, contributed to discussion, and reviewed/edited the manuscript. A.G.T. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Part of this study was published previously in abstract form at the 67th Scientific Sessions of the American Diabetes Association, Chicago, Illinois, 22–26 June, 2007 (abstract number: A529).

Conflict of interest

The authors O. Véber, A. Wilde, J. Demeter, G. Tamás, I. Mucsi, and A.G. Tabák declare that they have no conflict of interest.

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Authors and Affiliations

  1. Institute of Behavioural Sciences, Semmelweis University Faculty of Medicine, Budapest, Hungary

    O. Véber & I. Mucsi

  2. Institute of Pathophysiology, Semmelweis University Faculty of Medicine, Budapest, Hungary

    O. Véber & I. Mucsi

  3. Department of Pediatrics, Jávorszky Ödön Hospital, Vác, Hungary

    A. Wilde

  4. 1st Department of Medicine, Semmelweis University Faculty of Medicine, 2/a Korányi Sándor Str, 1083, Budapest, Hungary

    J. Demeter, G. Tamás & A. G. Tabák

  5. Division of Nephrology, Department of Medicine, McGill University Health Centre, Royal Victoria Hospital, Montreal, QC, Canada

    I. Mucsi

  6. Department of Epidemiology and Public Health, University College London, London, UK

    A. G. Tabák

Authors
  1. O. Véber
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  2. A. Wilde
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  3. J. Demeter
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  4. G. Tamás
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  5. I. Mucsi
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  6. A. G. Tabák
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Corresponding author

Correspondence to A. G. Tabák.

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Véber, O., Wilde, A., Demeter, J. et al. The effect of steroid pulse therapy on carbohydrate metabolism in multiple myeloma patients: a randomized crossover observational clinical study. J Endocrinol Invest 37, 345–351 (2014). https://doi.org/10.1007/s40618-013-0027-8

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  • DOI: https://doi.org/10.1007/s40618-013-0027-8

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