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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 2 mg/day treatment evidence for differing effects on insulin secretio



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 2 mg/day treatment evidence for differing effects on insulin secretio







To determine the time-course and prandial effects of short-term medium-dose prednisone on 24-hour metabolic patterns under standardized conditions. Glucocorticoids (GCs) adversely affect glucose homeostasis but 24-hour profiles of glucose, insulin, C-peptide and free fatty acids (FFAs) following short-term medium-dose prednisone treatment in persons with varying degrees of glucose tolerance are not well-defined. An open-label cross-sectional interventional study.Subjects: Three groups were prospectively studied: persons with type 2 diabetes (T2DM) (n = 7), individuals at risk for T2DM (AR) (n = 8) and persons with normal glucose tolerance (NGT) (n = 5). Before and after 3-day treatment with prednisone 2 mg each morning, subjects underwent 24-hour frequent blood sampling. Eucaloric mixed meals were provided at 8 h, 12 h and 18 h. Insulin/glucose ratio provided an estimate of ?-cell response to meal stimuli. Plasma glucose, insulin, C-peptide, haemoglobin A1c and FFA. Prednisone induced greater increases in glucose levels from midday (P = .1) to midnight (P = .2) in the T2DM than the AR and NGT groups. In contrast, insulin (P = .3) and C-peptide (P = .4) levels decreased post-breakfast in the T2DM group, whereas no changes in the morning but higher C-peptide levels (P = .3) from midday to midnight were observed in the AR group. In the T2DM group, insulin/glucose ratio decreased post-breakfast (P = .4) and increased post-dinner (P = .3). Fasting glucose, insulin and C-peptide levels were unchanged in all groups, and FFA levels modestly increased post-dinner (P = .3) in the NGT group. Short-term medium-dose prednisone treatment induces postprandial hyperglycaemia in T2DM and AR predominantly from midday to midnight due 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-hour total duration of effect.

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Accession: 036228800

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DOI: 10.1111/j.1365-2265.2011.04242.x


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