Steroid-induced diabetes in lupus nephritis patients: Classic risk factors or a different type of diabetes?
Journal
Lupus
ISSN
0961-2033
Publisher
SAGE Publications
Date Issued
2025
Author(s)
Dimas-Ramírez, Cristian Alejandro
Fortanell-Meza, Luis André
San Agustín-Morales, Diego
Brenner Muslera, Eduardo
Mejía-Vilet, Juan Manuel
Almeda-Valdes, Paloma
Vázquez-Cárdenas, Paola
Merayo-Chalico, Javier
Barrera-Vargas, Ana
Type
text::journal::journal article
Abstract
Background: Glucocorticoids are frequently employed in systemic lupus erythematosus (SLE) patients and play a critical role in the induction therapy of lupus nephritis (LN), despite their many side effects, including steroid-induced diabetes (SID). Information regarding SID in SLE patients is quite scant. Purpose: The aim of this study was to determine risk factors associated with the development of SID in patients with LN. Research Design: A nested case-control study was conducted. Study sample: We included patients with biopsy-proven LN, who received induction treatment with steroids. Data Collection and/or Analysis: Out of the total of 358 patients, 35 (9.7%) developed SID. Results: Patients with SID had more metabolic risk factors, including the metabolic score for insulin resistance (METS-IR); more factors related with lupus activity, with higher SLEDAI and SLICC-DI scores; and lower cumulative pre-induction steroid dose. A higher percentage of patients who developed SID received steroid pulses and a lower percentage received antimalarials. After logistic regression, the variables significantly associated with the development of SID were the SLEDAI index (OR 1.25 [95% CI 1.04–1.50], p 0.01), SLICC-DI (OR 4.93 [95% CI 2.14–11.3], p < 0.001), METS-IR (OR 1.17 [95% CI 1.04–1.32], p 0.009), delta METS-IR at 6 months (OR 1.20 [95% CI 1.03–1.39], p 0.01), and the use of antimalarials (OR 0.14, [95% CI 0.02–0.85], p 0.03). After propensity score matching, METS-IR remained a significant predictor of SID. Patients with METS-IR >36.8 were at higher risk (OR: 2.83, 95% CI: 1.09–7.36, p = 0.034). Conclusions: In conclusion, SDI development in patients receiving induction therapy for LN is associated with both classic metabolic risk factors and SLE-specific factors, and antimalarial use could be associated with a protective effect. Rheumatologists should be aware of this potential complication, in order to implement appropriate management strategies. ©The authors ©Lupus ©SAGE Publications.
License
Acceso Restringido
How to cite
Dimas-Ramírez, C. A., Fortanell-Meza, L. A., San Agustín-Morales, D., Brenner-Muslera, E., Mejía-Vilet, J. M., Almeda-Valdes, P., Vázquez-Cárdenas, P., Merayo-Chalico, J., & Barrera-Vargas, A. (2025). Steroid-induced diabetes in lupus nephritis patients: Classic risk factors or a different type of diabetes? Lupus, 34(3), 234–242. https://doi.org/10.1177/09612033251315976