PREDICTORS OF CHANGE IN INSULIN SENSITIVITY DURING GLUCOCORTICOID TREATMENT

Glucocorticoid induced alterations in carbohydrate metabolism can resu lt in hyperglycemia. We evaluated changes in carbohydrate metabolism p roduced by four days of prednisone (20 mg PO TID) measuring insulin se nsitivity, basal glucose, basal insulin and first phase insulin releas e (FPIR). We correlated these measures of carbohydrate metabolism with changes in free fatty acids and lactate levels both of which have bee n reported to be possible mediators of insulin sensitivity. Insulin se nsitivity decreased by 64% (p = 0.002), basal insulin levels increased 50% (p = 0.026), FPIR tripled (p = 0.064) while fasting glucose level s increased significantly but remained normal. Basal FFAs levels incre ased (p = 0.045) while lactate levels did not change significantly, an d neither predicted changes in SI. Basal levels of SI and FPIR were fo und to be independent predictors of change in insulin sensitivity and together explained 83% of the change in insulin sensitivity produced b y short term treatment with prednisone.