The Effects of Medium-to-Low Dose Glucocorticoids on Glucose Profiles in Patients with Interstitial Pneumonia with Autoimmune Features (IPAF) Evaluated by Continuous Glucose Monitoring System (CGMS): An Observational Study

Abstract Background: Few studies focused on the effects of medium-to-low dose glucocorticoids on glucose profiles and glucose metabolism in patients with interstitial pneumonia with autoimmune features (IPAF). Continuous glucose monitoring system (CGMS) can provide more detailed glucose features than fingertip blood samplings.Methods: This was a observational study in a teaching hospital. Outpatients with IPAF on 15mg prednisone per day for at least 3 months were recruited to receive CGMS and blood tests. The primary data of CGMS were analyzed to demonstrate the glucose features. Data were compared between subjects with a glucocorticoid treatment duration of more than 2 years(Group 1) and subjects with that of less than 2 years(Group 2). In subgroup analysis, among all subjects, subjects who tapered the daily dose to 7.5mg for at least 3 months received second tests. Results: 93% (27/29) on daily 15mg prednisone and all subjects on daily 7.5mg prednisone were with glucocorticoid induced hyperglycemia(GIH). Among subjects on daily 15mg prednisone, glucose AUC of 3 hours post-lunch was significantly higher than those post-breakfast and post-dinner, and mean glucose levels of half an hour pre-lunch and pre-dinner were significantly higher than that pre-breakfast. 81.9% of nocturnal glucose nadirs presented after 5AM, leading to relatively low fasting glucose values. There were no significant differences of glucose profiles between Group 1 and Group 2. No significant differences of CGMS and laboratory parameters were found between on daily 15mg prednisone and on daily 7.5mg prednisone.Conclusions: A large proportion of outpatients on medium-to-low-dose glucocorticoids are with GIH. Post-lunch glucose or post-dinner glucose are good indicators, while fasting glucose is not. The similar glycemic effects of daily 15mg and 7.5mg prednisone provide evidence for physicians to choose long-term maintaining glucocorticoid dose.Clinical Research Registration: This research is registered at clinicaltrials.gov(No.NCT02824757) with the registry named The Effects of Glucocorticoids on Glucose Metabolism in Patients With Interstitial Lung Disease. The URL is https://clinicaltrials.gov/ct2/show/NCT02824757?term=NCT02824757&draw=2&rank=1.This research is registered at July 7th,2016, retrospectively.