The novel mechanism of steroid-induced diabetes mellitus

Background: Steroid-induced diabetes (SID) may be due to either insulin resistance (IR) or beta cell dysfunction or combination of both. Several studies have established that these effects of steroids may be mediated by an osteoblast-derived protein called osteocalcin (OC). However, this effect has been described only in diabetic patients and has not been studied in SID patients. Aim and study design: A prospective observational study was designed to evaluate the correlation between serum OC level and blood glucose profile, in patients on steroids. Results: Out of a total of 88 subjects who were on steroid therapy, 42 (47.7%) subjects had their blood sugar levels in the diabetic range. Based on the glycemic status, subjects were divided into three groups, namely, normal, prediabetic, and diabetic. The patients who developed SID were older than normal (mean age 43.15 vs 39.27 years). The age (r = − 0.105 p = 0.5), BMI (r = − 0.3 p = 0.07), and abdominal obesity (r = − 0.32 p = 0.04) were negatively correlated with serum osteocalcin in diabetic group. Dose of steroids was negatively correlated with OC in all three groups. Fasting plasma glucose, fasting insulin, and IR were negatively correlated with OC in diabetic group. Conclusion: Decrease in serum osteocalcin level with increase in glycemic parameters in steroid-induced diabetic group points to the novel mechanism of steroid-induced diabetes.