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Kidney Week

Abstract: TH-PO587

Frequency and Risk Factors for Glucocorticoid-Induced Diabetes Mellitus: The Japan Nephrotic Syndrome Cohort Study

Session Information

Category: Glomerular Diseases

  • 1402 Glomerular Diseases: Clinical, Outcomes, and Trials

Authors

  • Ikeuchi, Hidekazu, Gunma Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Maebashi, Gunma, Japan
  • Hiromura, Keiju, Gunma Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Maebashi, Gunma, Japan
  • Yamamoto, Ryohei, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka, Japan
  • Nakagawa, Naoki, Asahikawa Ika Daigaku, Asahikawa, Hokkaido, Japan
  • Isaka, Yoshitaka, Osaka Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Suita, Osaka, Japan
Background

Glucocorticoid (GC)-induced diabetes mellitus (GIDM) is one of the major complications of glucocorticoid treatments. The study aims is to examine the incidence and risk factors for GIDM among patients (pts) with primary nephrotic syndrome in Japan.

Methods

We conducted a post-hoc analysis of the Japanese Syndrome Cohort Study (JNSCS), a nationwide prospective study of primary nephrotic syndrome. 374 pts who received renal biopsy between 2009 to 2010 were enrolled in JNSCS. After excluding 151 pts (no data for baseline HbA1c, no GC use, and already diabetes at baseline), 223 pts (104 male) were included. GIDM was defined when pts started diabetes medication within 6 months of GC treatment.

Results

Baseline clinical data were as follows: mean age 54.6±20.0 years, mean body mass index 23.4±3.6, eGFR 65.6±37.2 ml/min/1.73m2, and HbA1c 5.2±0.4%. GIDM was developed in 50 pts (22.4%) in 223 total pts, 14 pts (14.2%) in 98 minimal change diseases pts, 27 pts (30.3%) in 89 membranous nephropathy pts, 9 (33,3%) in 27 focal segmental glomerulosclerosis pts, and 0 pts (0%) in 9 other diseases pts. Multiple logistic regression analysis revealed age≥65 years and HbA1c≥5.6% before treatment are risk factors for the development of GIDM (Figure). Among 43 GIDM pts whose data were available, 15 pts (34.9%) discontinued diabetes medications within 2 years. There were no significant differences for adverse events (death, infections, vascular thrombosis, cardiovascular) and renal outcomes (complete remission, relapse, renal function deterioration) between patients with or without GIDM during 2 years after treatment.

Conclusion

About 20% of patients developed GIDM during the treatment of primary nephrotic syndrome in Japan. Older age and higher HbA1c levels at baseline are the risk factors for GIDM. One-third of GIDM patients could discontinue diabetes medications during 2 years after treatment.