EFFECTS OF METHYLPREDNISOLONE PULSE THERAPY ON INSULIN INJECTIONS IN PATIENTS WITH INSULIN-DEPENDENT DIABETES-MELLITUS

In this study we evaluated 31 insulin-dependent diabetes mellitus (IDD M) patients (ages 12.1+/-3.4 years, 18 males/13 females) who started o n multiple subcutaneous insulin injections (MSII) within six weeks of diagnosis and achieved either complete (CR: no insulin requirement and near-normoglycemia for at least two weeks) or incomplete (ICR: minimu m 50% decline in insulin requirement while maintaining near-normoglyce mia for two weeks or more) remissions within the first 12 weeks of the MSII trial. Methylprednisolone pulse therapy (MP) was administered fo ur times per day by IV bolus at a dose of 30 mg/kg (max. 1000 mg) on a lternate days. Eleven patients did not accept ''MP-pulse'' therapy; th erefore, we followed these cases (7 males/4 females) as the control gr oup. During the first year of follow-up, 13 patients from the ''MP pul se'' group achieved CR (3 males/1 female) or ICR (5 males/4 females) i n 3.5 to 14 months. Remission occurred in only two of the control grou p cases (1 male CR for 17 days and 1 female CR for 7 months). Of those with CR in the ''MP-pulse'' and control groups, all were greater than 12 years of age, and all but one in the ''MP-pulse'' group were males . The stimulation capacity of beta cells (as defined by percentage inc rease in serum C-peptide levels after glucagon injection) among CR cas es was found to be higher than that of non-remitted (NR) cases (p < 0. 05 at onset, p < 0.001 during MSH-induced remission and p < 0.05 at th e end of the first year of followup). Although patients with CR or ICR had higher beta cell reserves than NR cases at onset, only CR cases c ould sustain this capacity during the MSII-induced remission phase and one year after ''MP-pulse'' therapy. From this preliminary study, we conclude that ''MP-pulse'' therapy, may lead to prolonged near-normal beta cell function or partly preserved residual beta cell reserve duri ng the MSII-induced remission phase of IDDM. The beneficial effects of MP could be seen clearly in patients diagnosed during the late childh ood years.