The effect of steroid pulse therapy on carbohydrate metabolism in multiple myeloma patients

A randomized crossover observational clinical study

O. Véber, A. Wilde, J. Demeter, G. Tamás, I. Mucsi, A. Tabák

Research output: Article

1 Citation (Scopus)

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.

Original languageEnglish
Pages (from-to)345-351
Number of pages7
JournalJournal of Endocrinological Investigation
Volume37
Issue number4
DOIs
Publication statusPublished - 2014

Fingerprint

Carbohydrate Metabolism
Multiple Myeloma
Observational Studies
Steroids
Glucose
Dexamethasone
Therapeutics
Clinical Studies
Glucose Tolerance Test
Teaching Hospitals
Hyperglycemia
Cross-Over Studies
Type 2 Diabetes Mellitus
Glucocorticoids
Linear Models
Fasting

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology
  • Medicine(all)

Cite this

@article{5b79318e94e341c69a29b3d0cfbd9094,
title = "The effect of steroid pulse therapy on carbohydrate metabolism in multiple myeloma patients: A randomized crossover observational clinical study",
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.",
keywords = "Continuous glucose monitoring, Glucocorticoid-induced hyperglycemia, Impaired glucose metabolism, Multiple myeloma, Oral glucose tolerance test",
author = "O. V{\'e}ber and A. Wilde and J. Demeter and G. Tam{\'a}s and I. Mucsi and A. Tab{\'a}k",
year = "2014",
doi = "10.1007/s40618-013-0027-8",
language = "English",
volume = "37",
pages = "345--351",
journal = "Journal of Endocrinological Investigation",
issn = "0391-4097",
publisher = "Editrice Kurtis s.r.l.",
number = "4",

}

TY - JOUR

T1 - The effect of steroid pulse therapy on carbohydrate metabolism in multiple myeloma patients

T2 - A randomized crossover observational clinical study

AU - Véber, O.

AU - Wilde, A.

AU - Demeter, J.

AU - Tamás, G.

AU - Mucsi, I.

AU - Tabák, A.

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

KW - Continuous glucose monitoring

KW - Glucocorticoid-induced hyperglycemia

KW - Impaired glucose metabolism

KW - Multiple myeloma

KW - Oral glucose tolerance test

UR - http://www.scopus.com/inward/record.url?scp=84900542327&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84900542327&partnerID=8YFLogxK

U2 - 10.1007/s40618-013-0027-8

DO - 10.1007/s40618-013-0027-8

M3 - Article

VL - 37

SP - 345

EP - 351

JO - Journal of Endocrinological Investigation

JF - Journal of Endocrinological Investigation

SN - 0391-4097

IS - 4

ER -