Association Between The Glucocorticoid-induced Glucose Metabolic Disorders And Plasma Androgen Levels In The Patients With Renal Glomerular Disease

Objective: Decline in male androgen (testosterone and sex hormone binding globulin) levels was associated with insulin resistance and type 2 diabetes. Patients with renal glomerular diseases often required large doses, prolonged use of glucocorticoids. Glucocorticoids not only direct interference with glucose metabolism, but also affectted the levels of endogenous sex hormones, which caused indirectly abnormal glucose metabolism. Hyperglycemia and insulin resistance would increase further renal damage. Therefore searching risk factors of abnormal glucose metabolism induced by glucocorticoids, screening high-risk groups and monitoring the levels of their blood glucose, early detecting and intervening abnormal status, which would reduce the adverse effects of drugs and improve the quality of patients'life. This paper provided the evidence for screening high-risk groups and early diagnosis of steroid diabetes by means ofâ‘ comparing the differences in sex hormone concentration between normal glucose metabolism group before glucocorticoids treatment and diagnosed impaired glucose tolerance group before glucocorticoids treatmentâ‘¡comparing the differences in sex hormone concentration among normal glucose metabolism group, impaired glucose tolerance group and steroid diabetes after glucocorticoids treatment.Method: we selected 53 persons from patients with renal glomerular disease, which were confirmed by renal biopsy and clinical examination and hospitalized in the department of nephrology during July 2010-January 2011. Inclusion criteria:â‘ male,age≥18;â‘¡needing glucocorticoids treatment;â‘¢no previous history of diabetes;â‘£Serum creatinine<136μmol/L。Exclusion criteria:â‘ diagnosed with cirrhosis of liver, hepatic insufficiency, coronary heart disease, cardiac failure, endocrine diseases (for example hyperthyreosis, hypothyroidism, hypercortisolism and acromegaly) and malignant tumor;â‘¡using testosterone, estradiol, progesterone, desogestrel, cortisol, growth hormone and prolactin;â‘¢u sing non-hormonal drugs but those affecting concentrations of testosterone or sex hormone-binding globulin and the level of blood glucose, such as barbiturates,antiepileptic drugs,β-blockerâ…¢,calcineurin inhibitor, thiazide diuretics and so on.All subjects were measured body height, body weight, waist circumference and blood pressure. Blood samples was obtained in the morning in the fasting state before glucocorticoids therapy, to measure blood chemistry items and routine items. We recorded the amount of glucocorticoids with the equivalent value of prednisone. Measurement of sex hormones: drew off vein blood in the morning in the fasting state before glucocorticoids therapy, and tested the levels of testosterone and sex hormone binding globulin by chemiluminescence immunoassay. Measurement of the level of blood glucose:â‘ All subjects were tested the level of blood glucose before and 2 hours after meals, the level of fasting blood glucose(FBG) and fasting blood insulin, and the level of blood glucose and insulin after 2 hours of oral 75g glucose powder.( Chemiluminescence, IMMULITE,instruments and reagents were provided by American DBPC company).If the result of OGTT was different from the result of blood glucose, did the OGTT test again;â‘¡Caculate HOMA-IR according to the modal of HOMA;â‘¢Follow-up of one month since the beginning of glucocorticoids therapy, intermittently measured the level of blood glucose before and 2 hours after meals.Diagnostic criteria:â‘ Normal glucose tolerance(NGT):FBG≤6.0mmol/l, PBG<7.8mmol/l;Impaired glucose tolerance:FBG 6.1⁶.9mmol/l或PBG 7.8¹1.0mmol/l;Type 2 Diabete(sT2DM):FBG≥7.0mmol/l或PBG≥11.1mmol/l(All samples were from vein blood)â‘¡Diagnostic criteria of hypertension: without antihypertensive drugs and in resting state,not on the same day,the frequence of systolic blood pressure≥140mmHg and (or) diastolic blood pressure≥90mmHg was up to 3 times.Result:â‘ Comparison of statistics between the group of normal glucose tolerance and the group of impaired glucose tolerance before glucocorticoids therapy: there was no statistically significant difference in height, weight, BMI, waist circumference, cholesterol, triglycerides, high density lipoprotein, low density lipoprotein, lipoprotein a, albumin, serum creatinine; FBG, fasting insulin, HOMA-IR, TT, SHBG and the proportion of hypertention between two groups(all P>0.05).One month later of glucocorticoids therapy(there was no statistically significant difference in dose of glucocorticoids between two groups),there was no statistically significant difference in the proportion of steroid diabetes, but there were statistically significant difference in the proportion of abnormal glucose metabolism between two groups(p=0.008).There were statistically significant difference in age between two groups(P=0.006). And the group of impaired glucose tolerance were older than the group of normal glucose tolerance. After further adjustment for age, sex hormone levels between the two groups were still no statistically significant difference.â‘¡Follow-up one month since the beginning of glucocorticoids therapy, according to diagnostic criteria for glucose metabolism,divided into three groups: normal glucose tolerance group, impaired glucose tolerance group and steroid diabetes group. Comparison of statistics among the three groups:there was no statistically significant difference in height, weight, BMI, waist circumference, cholesterol, triglycerides, high density lipoprotein, lipoprotein a, serum creatinine; fasting blood glucose before glucocorticoids therapy, fasting insulin before glucocorticoids therapy, HOMA-IR, TT, SHBG, dose of glucocorticoids among the three groups(all P>0.05).Among three groups,steroid diabetes group with the oldest age(P=0.009,NGT=IGTIGT=DM),normal glucose tolerance group with the lowest albumin ( P=0.006 , NGT MH = 6.567, OR_MH 95% confidence interval (1.269,33.996). Removal of confounding effects of age, the steroid diabetes risk of hypertension was 6.567 times as much as normal blood pressure.Conclusion: In adult male patients with renal glomerular diseases (Scr<136μmol / L, no previous history of diabetes), there was no statistically significant difference in androgen between the group of normal glucose tolerance and the group of impaired glucose tolerance before glucocorticoids therapy. After one month of glucocorticoids therapy, case-control study between normal glucose tolerance group and steroid diabetes group showed that only age≥40 years and hypertension were risk factors of steroid diabetes and there was no statistically significant difference in androgen between the two groups.