Short-term tolerance of pulse methylprednisolone therapy in patients with diabetes mellitus

Purpose: To assess the short-term tolerance of pulse methylprednisolone in patients with diabetes. Design: Retrospective study in a national eye center. Participants: Eighty patients with type 2 diabetes, half of them also treated for hypertension, who received 3-day pulse methylprednisolone between January 1999 and December 2002 for eye disorders and were monitored according to a written protocol. Main Outcome Measure: Potentially serious side effects, serial blood glucose measurements, and hypoglycemic interventions during pulse therapy. Results: Each pulse induced about 10 hours later a mean 2-fold peak increase of blood glucose. According to a 14-mmol/l (250 mg/dl) threshold glucose level for intervention, rapid insulin was required in 27 of 27 (100%) and 24 of 53 (45%) patients with glycosylated hemoglobin levels higher than 8% and up to 8%, respectively. In the latter group, patients older than 70 years had a 3-fold increased risk of requiring insulin. Significant side effects were systolic and/or diastolic blood pressure elevation greater than or equal to 180/110 mmHg (n = 6), ketosis without acidosis (n = 5), silent myocardial ischemia (n = 1), and disorientation (n = 1). All side effects were transient or controlled successfully by medical intervention. No infectious complication occurred during the treatment period. Conclusions: Pulse methylprednisolone is globally well tolerated in diabetic patients, but requires strict blood glucose and clinical monitoring. (C) 2005 by the American Academy of Ophthalmology.