ESPE Abstracts

Background: SIDM is not a common complication of high-dose glucocorticoid therapy (HD-GC) in pediatric practice. There are no clear generally accepted approaches to SIDM treatment. In 10 cases, we present the identified patterns of predictors, course, features of the treatment of SIDM in children and adolescents.

Methods: 10 case histories of children with SIDM were analyzed. 4 boys, 6 girls, age 8-17.5 years, median 15 years. Underlying disease: 7 SLE, 1 arthritis with systemic onset, 1 dermatomyositis, 1 cystic fibrosis

Results: Persistent hyperglycemia was detected after 5 days - 1 month from the start of HD-GC (5 dexamethasone 10-16 mg/m2/day, 1 solumedrol 500 mg N5, 4 prednisolone 2 mg/kg/day) At presentation the average glycemia was 15 mmol/l, massive glucosuria in all patients, the average level of HbA1c was 6.4%, hemophagocytosis in 6 cases (60%), 9 patients had myopathy (steroid-induced) with inability to walk, resistant to treatment nephrotic syndrome in 5 cases, high insulin resistance was in all cases, 8 required of high doses (1.5-2.0 units/kg/day) 2 required of low doses (0.3-0.5 units/kg/day) of insulin, median 1.5 units/kg/day. The peak of hyperglycemia was after 13.00 in response to maximum steroids administration in the morning (before 10.00) The criterion for compensation was the absence of massive glucosuria, which was achieved with an average daily glycemia of less than 10 mmol/l. The classical basal-bolus scheme was used in 2 patients, compensation was not achieved, we observed postprandial hypoglycemia, high hyperglycemia in the evening, increase of the daily insulin doses. All patients received adapted regimen with using long-acting (glargine) and bolus administration of intermediate-acting (actrapid) analogs, the maximum dose of actrapide was admitted in the afternoon. 3 children died (complications of the underlying disease and infections), in 7 children SIDM resolved within 0.5-1.5 months after discontinuation of HD-GC. In 6 cases there was no recurrence of DM (observation period is more than 1 year), in 1 case IT was completed 3 weeks ago.

Conclusions: SIDM predictors are HD-GC using, particularly dexamethasone, SLE, severe myopathy, and nephrotic syndrome SIDM is characterized by high specific glycemic profile during the day, requiring modification of the classical basal-bolus regimen, using intermediate-acting analogs improves metabolic control. HbA1c is an unreliable criterion for compensation in SIDM SIDM is characterized by a high daily insulin doses, with a high rate of increase and decrease after HD-GC discontinuation. SIDM is completely resolved.