The effects of methylprednisolone pulse therapy on glucose metabolism parameters in children with autoimmune and autoinflammatory diseases

BACKGROUND: The use of glucocorticosteroids (GCS) in high doses can lead to hyperglycemia. GCS pulse therapy (PT) cause fewer side effects compared to long-term oral administration of GCS in adult patients. Glycemic control in children while GCS PT is not well studied.

AIM: To study short- and long-term effects of methylprednisolone pulse therapy on carbohydrate metabolism parameters in children with autoimmune and autoinflammatory diseases

MATERIALS AND METHODS: We analyzed carbohydrate metabolism parameters of patients before, during, and after PT with methylprednisolone (3 infusions; 0 h, 24 h, 48 h; total dose 27.0 (23.0; 31.6) mg/kg). Observation lasted for 0.2–6.3 years.

RESULTS: We analyzed data from 15 patients (13 girls, 2 boys). During PT, the glycemia level exceeded normal rages in all patients in 4-10 hours after the start of PT, reaching a peak in 7 h – 10.8 (9.9; 11.8) mmol/l. Glycemia peaks 7 h after the second and the third infusions were significantly lower compared to the first day – 9.1 (8.2; 10.7) mmol/l (p<0.05) and 8.9 (7.4; 9.2) mmol/l (p<0.01), correspondently. A tendency toward normalization of glycemia was noted in 24 h after each administration of GCS. Glycemic values in 72 h did not correlate with age, SDS BMI, methylprednisolone dose, and peak glycemic values during PT. There were no significant differences between the glycemic indices of patients undergoing PT for the first time and those who already had experience of PT. Observation for 2.7 (0.5; 4.6) years did not reveal any delayed complications.

CONCLUSION: GCS PT in children resulted in short-term GCS-induced hyperglycemia. Peak glycemia values were observed in 7 hours after each GCS infusion; the rises of glycemia after repeated infusions were lower than after the first one. Spontaneous glycemia normalization was observed in 24 hours after methylprednisolone administration. We did not reveal any delayed disorders of carbohydrate metabolism.

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