Impaired fasting glucose related to cumulative dose of prednisone in patients with leprosy reactions: a glucose monitoring and management protocol

Abstract

Abstract Purpose: Our aim was to analyze the effects of the cumulative prednisone dose on blood glucose levels in leprosy reaction (LR) participants without a pre-existing diagnosis of diabetes, using the fasting plasma glucose test, and to develop a protocol to assist in preventing hyperglycemia and glucocorticoid-induced diabetes mellitus (GIDM). Method: A cross-sectional study enrolled 75 outpatients with LR who were attended at a Reference Center from 2018 to 2020. The binomial test was used to analyze the association among groups and demographic/epidemiological factors. The Mann-Whitney test was used for the median comparison within groups regarding hematologic/biochemical variables. Results: The clinical forms of borderline-tuberculoid (41.9%; 13/31) and borderline-lepromatous (46.12%) were more prevalent in the groups with a cumulative prednisone dose of ≤4 and >12 months, respectively, compared to the other groups. The overall prevalence of impaired fasting glucose was 10.6% (8/75) when patients were assessed in the final phase of this study. A cumulative prednisone dose greater than 8 months, coupled with taking this corticosteroid during blood collection, was found to be associated with impaired fasting glucose. Furthermore, the comparison between patients taking prednisone (Prednisone+; Median:101mg/dL, Min.:74mg/dL, Max.:125mg/dL) and those without (Prednisone-; Median:76mg/dL, Min.:66mg/dL, Max.:99mg/dL) showed a significant difference (p=0.0176) after 12 months of cumulative dose. Conclusion: Based on the findings, we established a glucose monitoring and management protocol for patients with LR who are taking prednisone, mainly for more than 8 months. The purpose of this protocol is to detect, manage, and prevent the development of hyperglycemia and GIDM.