The Influence of Serum25(OH)D Level on Glucocorticoid Induced Abnormal Glucose Metabolism of Renal Glomerular Disease Patients

Objective: Glucocorticoid is widely used in treatment of patientswith glomerular disease, which needs large daily dosage and long duration; Itinduces abnormal glucose metabolism through a variety of ways, which is oneof the main side effects.Treeted with oral prednisone (0.8±0.11) mg/(kg d)for renal glomerular disease patients with normal glucose tolerance lasting for8to13weeks, the incidence of impaired glucose tolerance and steroiddiabetes were50%and25%, respectively. Studies have shown that serum25(OH) D has effects on various mechanisms related to the pathophysiologyof type2diabetes, including pancreatic beta cell dysfunction, impaired insulinaction and systemic inflammation. Low level of serum25(OH) D increasesthe risk of type2diabetes mellitus. The pathogenesis of steroid diabetes andtype2diabetes are the same.It is not clear weither serum25(OH) D level haseffects on the pathophysiology of steroid diabetes or not. In this case-controlstudy,we try to investigate the relationship between serum25(OH)D and theabnormal glucose metabolism of glomerular diseases patients treetedwith glucocorticoid through observing their serum25(OH) level and glucosemetabolism status,and finally try to provide some evidence for theprevention of steroid diabetes.Methods: There were61in-hospital patients with renal glomerulardisease confirmed by clinical renal biopsy from2013June to2013Novemberwho newly needs prednison therapy (0.79±0.10mg kg-1d-1) in-come to thecase group. We also selected the healthy checkup in16cases as control groupat the same period. Exclusion criteria:(1)People who were diagnosed withdiabetes.(2)Estimate glomerular filtration rate(eGFR)≤60ml·Kg-1·1.73m2.(3)Individuals who had take Vitamin D preparation, calcitonin, Si Bernard Casey,or drugs which influences blood glucose metabolism such as calcitioninin recent8weeks.(4) People with infection or acute kidney injury.(5) Peoplewith chronic liver disease, coronary heart disease, heart failer, endocrinediseases (such as hyperthyroidism, hypothyroidism, hyperparathyroidism,hypercortisolismand and so on), severe systemic diseases such as therioma.Record the age, blood pressure and body weight of each subjects,andalbumin, serum calcium, phosphorus and other biochemical indicators. Serum25(OH) D level was detected with the method of enzyme linkedimmunosorbent assay (ELISA)and the kit was provided by ENZO company,Ameirica.Before the treatment of glucocoticiod, all subjects should take OralGlucose Tolerance Test (oral50%Glucose Injection150ml).When thetreatment began, patients were taught to monitor and record their fasting andpostprandial glucose every2-3days in the first6weeks. At the end of thesix-week follow up,patients were were divided into NGR group, IGR groupand SDM group.Results:1Comparison between the control group, NGR group and IGR groupbefore the treatment: albumin in control group was significantly higher thanthat in NGR group and IGR group, while the24hours of urinaryprotein, cholesterol was significantly lower than that of NGR group and IGRgroup; The2hour postprandial blood glucose in IGR group was significantlyhigher than that in control group and NGR group; The serum25(OH) D levelin the control group was significantly higher than that in NGR groupwhile the NGR group was significantly higher than that in IGR group(64.09±13.53to50.81±12.44vs42.71±8.09, P<0.05). In the control group,4subjects (25%) had sufficient serum25(OH) D,8cases is insuficiency(50%)and4cases (25%) deficiency. While in the glomerular disease paients,only4cases (6.56%) had sufficient serum25(OH) D,while18cases (29.51%)were insufficiency and39cases (63.93%) were deficiency.25(OH) D level innephritis patients were significantly higher than in nephritic syndromepatients (56.94±10.41vs45.88±11.55, P<0.05). 26weeks after the treetment,15cases (34.88%) of the NGRgroup developed into impaired glucose tolerance while9cases (20.93%)developed into steroid diabetes, for a median of7days;11cases (61.11%) ofthe IGR group occurred steroids diabetes mellitus, for a median of3days,and7cases (38.89%) still had impaired glucose tolerance.The incidence forsteroid diabetes in IGR group was significantly higher than that in groupNGR (P<0.05). According to the glucose tolerance status after6weeksglucocoticold application, all the patients were divided into NGR group of19cases,IGR group of22cases and SDM group of20cases. Albumin in thecontrol group was significantly higher than the other groups while theconstituent ratio of hypertension and the24hours of urinary protein weresignificantly lower than the other groups; The2hour postprandial bloodglucose in IGR group and SDM at baseline were significantly higher thanthose in NGR group and control group,(7.24±1.42,7.84±1.64vs5.42±0.99,6.12±0.57, P<0.05);Glycosylated hemoglobin in NGR group and IGR groupwere lower than that in SDM group (4.94±0.51,5.12±0.50vs5.6±0.76,P<0.05); The baseline25(OH) D level in the control group was significantlyhigher than that in NGR group, IGR group and SDM group while that in NGRgroup, IGR group was significantly higher than SDM group (64.09±13.53vs55.68±13.09,48.97±9.91vs40.91±7.82, P<0.05); There was no significantdifference between NGR group and IGR group.3Serum25(OH) D level was positively correlated with serum albuminand corrected serum calcium, and the correlation coefficient were0.455(P=0.00) and0.317(P<0.05)respectively, while negatively correlatedwith BMI, cholesterol, the2hour postprandial blood glucose and24hour ofurinary protein, the correlation coefficients were r=-0.302(P<0.05),r=-0.27(P<0.05),r=-0.361(P<0.05), r=-0.339(P<0.05); Serum25(OH) D wasalso correlated with season, correlation coefficient is-0.308(P<0.05).4The relationship between serum25(OH)D and steroid diabetes:Logistic regression analysis indicated that subjects with25(OH)D<50nmol/Lor HbA1c>5.6%had a risk of5.586or5.197times of developing Steroid Diabetes compared with those who below that levels, respectively. With theage increased10years or insulin resistance index increased one, the risk ofoccurred SDM increased2.443、2.755times,respectively.Conclusion: Mostglomerular disease patients are serum25(OH) D deficiency orinsufficiency; Low level of serum25(OH) D is one of the main risk factorsfor the occurrence of steroid diabetes in glomerular disease patients treetedwith glucocoticiod.