Glukokortikoidi su učinkoviti u liječenju širokog spektra kroničnih autoimunih i upalnih bolesti. Liječenje glukokortikoidima povezano je sa značajnim metaboličkim nuspojavama uključujući inzulinsku rezistenciju i šećernu bolest. Predisponirajući čimbenici za pojavu steroidnog dijabetesa su starija dob, povećana tjelesna masa, obiteljska anamneza šećerne bolesti i gestacijski dijabetes. Nekoliko mehanizama pridonose pojavi steroidnog dijabetesa, uključujući smanjenje periferne inzulinske osjetljivosti, povećanje proizvodnje glukoze u jetri i ometanje proizvodnje i lučenja inzulina iz gušterače. Liječnici koji liječe bolesnike glukokortikoidima trebali bi biti upućeni u metaboličke poremećaje koje oni uzrokuju. U liječenju steroidnog dijabetesa mogu se koristiti sve skupine antidijabetika, ali inzulinska terapija bio bi najbolji izbor u liječenju većine bolesnika sa steroidnim dijabetesom.Glucocorticoids (GC) are the cornerstone in the treatment of numerous chronic autoimmune and inflammatory diseases. GC treatment is accompanied by significant metabolic adverse effects, including insulin resistance, glucose intolerance and diabetes, visceral adiposity, dyslipidemia and skeletal muscle atrophy. GCs are the most common cause of drug-induced diabetes mellitus. However, not everyone treated with glucocorticoids develops diabetes. Predictors of development of diabetes are age, weight, family history of diabetes mellitus, or personal history of gestational diabetes. There is evidence that patients with decreased insulin secretory reserve are much more likely to develop diabetes. Diabetes from topical steroid use is uncommon, but high-dose steroids have been associated with significant hyperglycemia, including development of hyperglycemic hyperosmolar syndrome and even diabetic ketoacidosis in patients with type 1 diabetes mellitus. Several mechanisms contribute to the development of hyperglycemia and steroid-induced diabetes, including decreased peripheral insulin sensitivity, increased hepatic glucose production, and inhibition of pancreatic insulin production and secretion. Physicians treating patients with GCs should be aware of the induction of metabolic disturbances and should not solely rely on fasting measurements. In addition, our review indicates that insulin therapy could be considered when treating patients on GC therapy
