From the Guidelines
An elevated A1C caused by steroid use is not the same as having diabetes, though it is often called steroid-induced hyperglycemia. Steroids like prednisone, dexamethasone, and methylprednisolone can temporarily raise blood sugar levels by increasing insulin resistance and stimulating glucose production in the liver, as noted in studies 1. This elevation typically resolves when the steroids are discontinued or reduced. However, if your A1C remains elevated (6.5% or higher) after stopping steroids, or if you require medication to control your blood sugar while on steroids, you may be diagnosed with steroid-induced diabetes.
The diagnosis of diabetes is typically based on plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-h value in the 75-g oral glucose tolerance test (OGTT), or an A1C test with a threshold of 6.5% 1. The A1C test is a widely used marker of chronic glycemia, reflecting average blood glucose levels over a 2- to 3-month period of time, and is highly standardized, allowing for uniform application across populations 1.
Some key points to consider in the diagnosis of diabetes include:
- The A1C test should be performed using a method that is certified by the National Glycohemoglobin Standardization Program (NGSP) and standardized to the Diabetes Control and Complications Trial (DCCT) assay 1.
- Marked discordance between measured A1C and plasma glucose levels should raise the possibility of A1C assay interference due to hemoglobin variants (i.e., hemoglobinopathies) and consideration of using an assay without interference or plasma blood glucose criteria to diagnose diabetes 1.
- In conditions associated with an altered relationship between A1C and glycemia, such as sickle cell disease, pregnancy, glucose-6-phosphate dehydrogenase deficiency, HIV, hemodialysis, recent blood loss or transfusion, or erythropoietin therapy, only plasma blood glucose criteria should be used to diagnose diabetes 1.
While on steroids, blood sugar monitoring is important, and your doctor might prescribe temporary diabetes medications like metformin or insulin if needed. Lifestyle modifications including regular physical activity and a diet low in refined carbohydrates can help manage steroid-induced blood sugar elevations. It is essential to work closely with a healthcare provider to monitor and manage steroid-induced hyperglycemia and to determine the best course of treatment.
From the FDA Drug Label
In particular, the increased risk of diabetes mellitus, fluid retention and hypertension in elderly patients treated with corticosteroids should be considered. The use of corticosteroids, such as prednisone, can increase the risk of diabetes mellitus. However, an elevated A1c from steroids does not necessarily count as diabetes.
- The FDA label mentions the increased risk of diabetes mellitus in elderly patients treated with corticosteroids, but it does not provide a clear definition of what constitutes diabetes in this context.
- It is essential to consult with a healthcare professional to determine if an elevated A1c from steroids indicates diabetes or another condition 2.
From the Research
Definition of Diabetes and Elevated A1C
- Diabetes is typically defined as a condition characterized by elevated blood glucose levels, with hemoglobin A1c (HbA1c) levels being a key indicator of long-term glucose control 3.
- An HbA1c level of 7% or higher is often used as a threshold to indicate poor blood glucose control in diabetic patients 3.
Impact of Steroids on A1C Levels
- Research suggests that corticosteroid treatment can lead to a transient elevation in serum glucose levels in diabetic patients, which may result in elevated HbA1c levels 3, 4.
- However, the extent to which steroid-induced hyperglycemia affects HbA1c levels can vary depending on factors such as the dose and duration of steroid treatment, as well as individual patient characteristics 4.
Diagnosis of Diabetes in Patients with Elevated A1C due to Steroids
- It is essential to consider the clinical context and potential underlying causes of elevated HbA1c levels, including steroid use, when diagnosing diabetes 5.
- A diagnosis of diabetes should be based on a comprehensive evaluation of clinical and laboratory findings, rather than relying solely on HbA1c levels 5.
Management of Prediabetes and Diabetes
- Lifestyle modification, including calorie restriction, increased physical activity, and self-monitoring, is a crucial component of diabetes prevention and management 6, 7, 5.
- Metformin may also be effective in reducing the risk of diabetes progression and improving glycemic control in patients with prediabetes or diabetes 6, 7, 5.