A retrospective observational study of glucocorticoid-induced diabetes mellitus with IgA nephropathy treated with tonsillectomy plus methylprednisolone pulse therapy.

To evaluate the incidence of GC-DM among patients with immunoglobulin A nephropathy (IgAN) and to confirm the risk factors for the development of GC-DM.The medical records of patients with IgAN newly treated with the protocol of tonsillectomy combined with steroid pulse therapy were reviewed. The primary outcome was the development of GC-DM within the hospitalization period and during one year of follow-up.During hospitalization, 19 of the 95 patients developed GC-DM (20.0%), and the patients with GC-DM were significantly older and had a higher rate of family history of diabetes and higher HbA1c levels. The prevalence of hypertension was higher and the eGFR was numerically lower in patients with GC-DM than in those without. Older age (≥45 years) and a family history of diabetes emerged as independent risk factors for the development of GC-DM (odds ratio [OR], 6.3 and 95% confidence interval [CI], 1.6-27.6; OR, 4.4 and 95% CI, 1.2-16.6, respectively). No patients were newly diagnosed with GC-DM during 1-year observation period at out-patient clinic.Among the patients with IgAN, 20% developed GC-DM during the hospitalization period, confirming the family history of diabetes is clinically necessary before starting GC therapy

Risk factors for GC-DM.

<p>The multivariate analysis revealed an older age (≥45 years) and a family history of diabetes to be independent risk factors for the development of GC-DM during hospitalization. In a logistic regression analysis, older age (≥45 years) and a family history of diabetes emerged as independent risk factors for the development of GC-DM (odds ratio [OR], 6.3 and 95% confidence interval [CI], 1.6–27.6; OR, 4.4 and 95% CI, 1.2–16.6, respectively).</p

Comparison of the baseline characteristics of the patients with and without GC-DM treatment at one year.

<p>Comparison of the baseline characteristics of the patients with and without GC-DM treatment at one year.</p

Schematic illustration of the protocol.

<p>Patients received methylprednisolone (mPSL) pulse (500 mg daily) administered intravenously for 3 consecutive days followed by oral prednisolone (30 mg daily) on 4 consecutive days, with the course repeated 3 times during hospitalization. Oral prednisolone (30 mg) was then given on every alternate day and gradually tapered and discontinued at 1 year.</p

Comparison of the baseline characteristics of the patients with and without GC-DM during hospitalization.

<p>Comparison of the baseline characteristics of the patients with and without GC-DM during hospitalization.</p