Back to Search
Start Over
Effect of acute and chronic glucocorticoid therapy on insulin sensitivity and postprandial vascular function.
- Source :
-
Clinical endocrinology [Clin Endocrinol (Oxf)] 2016 Apr; Vol. 84 (4), pp. 501-8. Date of Electronic Publication: 2015 Nov 23. - Publication Year :
- 2016
-
Abstract
- Objective: Postprandial hyperglycaemia is associated with increased arterial stiffness and cardiovascular events. Low-dose prednisolone causes insulin resistance that typically manifests as postprandial hyperglycaemia. We investigated whether prednisolone causes postprandial vascular dysfunction in a cohort of patients with rheumatoid arthritis.<br />Design: An open interventional and cross-sectional study was undertaken.<br />Patients and Measurements: Eighteen subjects with rheumatoid arthritis who had not taken oral glucocorticoids for ≥6 months were studied before and after prednisolone 6 mg/day for 7 days to determine the acute effects of prednisolone. Pre-prednisolone data were compared to 18 subjects with rheumatoid arthritis taking long-term (>6 months) prednisolone (6·5 ± 1·8 mg/day) to assess the chronic effects of prednisolone. Augmentation index (by applanation tonometry) and reactive hyperaemia index (by peripheral artery tonometry) were measured before and after a mixed-meal (10 kcal/kg, 45% carbohydrate, 15% protein, 40% fat). Insulin sensitivity was estimated by the Matsuda index and sympathetic nervous system activity from urinary noradrenaline excretion.<br />Results: Matsuda index was lower after acute (2·0 ± 1·0 vs 3·6 ± 1·1, P = 0·01) and chronic (1·9 ± 1·0 vs 3·6 ± 1·1, P = 0·04) prednisolone. Postprandial augmentation index was lower after acute prednisolone (2551 ± 197 vs 2690 ± 272%*min, P ≤ 0·001), but not chronic prednisolone. There were no significant differences in reactive hyperaemia index with acute or chronic prednisolone. Noradrenaline excretion was lower after acute (54 ± 8 vs 93 ± 23 nmol/6 h, P = 0·02), but not chronic, prednisolone.<br />Conclusions: Prednisolone-induced insulin resistance is not associated with postprandial vascular dysfunction in patients with rheumatoid arthritis. Reduced sympathetic activity may contribute to the reduction in postprandial arterial stiffness with acute prednisolone.<br /> (© 2015 John Wiley & Sons Ltd.)
- Subjects :
- Aged
Arthritis, Rheumatoid blood
Arthritis, Rheumatoid physiopathology
Cross-Sectional Studies
Drug Administration Schedule
Female
Glucocorticoids administration & dosage
Glucocorticoids therapeutic use
Humans
Hyperglycemia blood
Hyperglycemia physiopathology
Male
Middle Aged
Postprandial Period
Prednisolone administration & dosage
Time Factors
Treatment Outcome
Vascular Stiffness drug effects
Arthritis, Rheumatoid drug therapy
Blood Glucose analysis
Insulin Resistance physiology
Prednisolone therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1365-2265
- Volume :
- 84
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Clinical endocrinology
- Publication Type :
- Academic Journal
- Accession number :
- 26493042
- Full Text :
- https://doi.org/10.1111/cen.12966