From the Guidelines
The hyperglycemic effect of oral corticosteroids like prednisone can last throughout the day, with peak effects typically occurring in the evening, as evidenced by continuous glucose monitoring (CGM) studies 1. The duration of the hyperglycemic effect caused by oral corticosteroids, such as prednisone, is influenced by the medication's pharmacologic actions, which can persist for several hours after administration.
- Key factors to consider include:
- The type and duration of action of the glucocorticoid
- The dose and frequency of administration
- The individual's underlying glucose metabolism and presence of pre-existing diabetes According to the most recent guidelines on diabetes care in the hospital, daily-ingested intermediate-acting glucocorticoids like prednisone reach peak plasma levels in 4–6 hours, but their effects on glucose metabolism can be observed throughout the day 1.
- The typical glycemic pattern for individuals treated with daily prednisone is characterized by:
- Normal or mild fasting hyperglycemia
- Increasing hyperglycemia during the afternoon
- Peak hyperglycemia in the evening This pattern is more pronounced in individuals with type 2 diabetes than in those without diabetes, highlighting the importance of monitoring and adjusting treatment accordingly 1.
From the Research
Duration of Hyperglycemic Effect
The duration of the hyperglycemic effect caused by oral corticosteroids, such as prednisone, can vary depending on several factors, including the dose and duration of treatment.
- A study published in 2012 2 found that short-term, medium-dose prednisone treatment induced postprandial hyperglycemia in patients with type 2 diabetes and those at risk for type 2 diabetes, with the effect lasting from midday to midnight.
- Another study published in 2023 3 found that mixed insulin can improve control of prednisolone-induced hyperglycemia, with the effect of prednisolone on blood glucose levels lasting for less than 24 hours.
- A study published in 1975 4 found that treatment with oral prednisone for 1 day raised blood glucose levels in healthy individuals, with the effect lasting for at least 28 hours.
Factors Affecting Duration
Several factors can affect the duration of the hyperglycemic effect of oral corticosteroids, including:
- Dose and duration of treatment: Higher doses and longer durations of treatment can lead to a longer duration of hyperglycemic effect 2, 3.
- Individual characteristics: Patients with type 2 diabetes and those at risk for type 2 diabetes may experience a longer duration of hyperglycemic effect compared to those with normal glucose tolerance 2.
- Timing of treatment: The timing of treatment can also affect the duration of hyperglycemic effect, with postprandial hyperglycemia lasting from midday to midnight 2.