Glucocorticoid-associated blood glucose response and MS relapse recovery

Myla D. Goldman; Scott Koenig; Casey Engel; Christopher R. McCartney; Min Woong Sohn

doi:10.1212/NXI.0000000000000378

Glucocorticoid-associated blood glucose response and MS relapse recovery

Myla D. Goldman, Scott Koenig, Casey Engel, Christopher R. McCartney, Min Woong Sohn

Research output: Contribution to journal › Article › peer-review

3 Scopus citations

Abstract

To determine the relationship between MS relapse recovery and blood glucose (BG) response to IV methylprednisolone (IVMP) treatment. Methods: We retrospectively identified 36 patients with MS admitted for IVMP treatment of acute relapse who had adequate data to characterize BG response, relapse severity, and recovery. The relationship between glucocorticoid-associated nonfasting BG (NFBG) and relapse recovery was assessed. Results: Highest recorded nonfasting BG (maximum NFBG [maxNFBG]) values were significantly higher in patients with MS without relapse recovery compared with those with recovery (271 ± 68 vs 209 ± 48 mg/dL, respectively; p = 0.0045). After adjusting for relapse severity, MS patients with maxNFBG below the group median were 6 times (OR = 6.01; 95% CI, 1.08-33.40; p = 0.040) more likely to experience relapse recovery than those with maxNFBG above the group median. In a multiple regression model adjusting for age, sex, and relapse severity, a 1-mg/dL increase in the maxNFBG was associated with 4.5% decrease in the probability of recovery (OR = 0.955; 95% CI, 0.928-0.983; p = 0.002). Conclusions: These findings suggest that higher glucocorticoid-associated NFBG values in acutely relapsing patients with MS are associated with diminished probability of recovery. This relationship could reflect steroid-associated hyperglycemia and/or insulin resistance, defects in non-steroid-associated (e.g., prerelapse) glucose metabolism, or both. This study included only those admitted for an MS relapse, and it is this subset of patients for whom these findings may be most relevant. A prospective study to evaluate glucose regulation and MS relapse recovery in a broader outpatient MS population is under way.

Original language	English
Article number	378
Journal	Neurology: Neuroimmunology and NeuroInflammation
Volume	4
Issue number	5
DOIs	https://doi.org/10.1212/NXI.0000000000000378
State	Published - 2017

Bibliographical note

Publisher Copyright:
© 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Funding

Study was funded in part by the NIH–NINDS (K23NS062898). Additional project funding was provided by the ziMS Foundation. From the Department of Neurology (M.D.G.), Division of Endocrinology and Metabolism, Department of Medicine (C.R.M.), and Department of Public Health Sciences (M.-W.S.), University of Virginia School of Medicine, Charlottesville; University of Maryland School of Medicine (S.K.), Baltimore; and University of Virginia College of Arts and Sciences (C.E.), Charlottesville. Funding information and disclosures are provided at the end of the article. Go to Neurology.org/nn for full disclosure forms. The Article Processing Charge was funded by ziMS Foundation (MDG). This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. M.D. Goldman served on the scientific advisory board for Novartis, Biogen, Acorda, Questcor, Genzyme, and EMD Serono; received travel funding from Acorda and Biogen; received institutional contracts from Biogen and Novartis; and received research support from NINDS and ziMS Foundation. S. Koenig and C. Engel report no disclosures. C.R. McCartney received research support from NIH.NICHD and National Multiple Sclerosis Foundation. M.-W. Sohn reports no disclosures. Go to Neurology.org/nn for full disclosure forms.

Funders	Funder number
MDG
NIH.NICHD
National Institutes of Health (NIH)
Institute of Neurological Disorders and Stroke National Advisory Neurological Disorders and Stroke Council	K23NS062898
Institute of Neurological Disorders and Stroke National Advisory Neurological Disorders and Stroke Council
National Multiple Sclerosis Society
Novartis
Biogen IDEC
ziMS Foundation

ASJC Scopus subject areas

Neurology
Clinical Neurology

Access to Document

10.1212/NXI.0000000000000378

Cite this

@article{ee65fc72bbf041078c9a23fb1674d2f5,

title = "Glucocorticoid-associated blood glucose response and MS relapse recovery",

abstract = "To determine the relationship between MS relapse recovery and blood glucose (BG) response to IV methylprednisolone (IVMP) treatment. Methods: We retrospectively identified 36 patients with MS admitted for IVMP treatment of acute relapse who had adequate data to characterize BG response, relapse severity, and recovery. The relationship between glucocorticoid-associated nonfasting BG (NFBG) and relapse recovery was assessed. Results: Highest recorded nonfasting BG (maximum NFBG [maxNFBG]) values were significantly higher in patients with MS without relapse recovery compared with those with recovery (271 ± 68 vs 209 ± 48 mg/dL, respectively; p = 0.0045). After adjusting for relapse severity, MS patients with maxNFBG below the group median were 6 times (OR = 6.01; 95\% CI, 1.08-33.40; p = 0.040) more likely to experience relapse recovery than those with maxNFBG above the group median. In a multiple regression model adjusting for age, sex, and relapse severity, a 1-mg/dL increase in the maxNFBG was associated with 4.5\% decrease in the probability of recovery (OR = 0.955; 95\% CI, 0.928-0.983; p = 0.002). Conclusions: These findings suggest that higher glucocorticoid-associated NFBG values in acutely relapsing patients with MS are associated with diminished probability of recovery. This relationship could reflect steroid-associated hyperglycemia and/or insulin resistance, defects in non-steroid-associated (e.g., prerelapse) glucose metabolism, or both. This study included only those admitted for an MS relapse, and it is this subset of patients for whom these findings may be most relevant. A prospective study to evaluate glucose regulation and MS relapse recovery in a broader outpatient MS population is under way.",

author = "Goldman, \{Myla D.\} and Scott Koenig and Casey Engel and McCartney, \{Christopher R.\} and Sohn, \{Min Woong\}",

note = "Publisher Copyright: {\textcopyright} 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.",

year = "2017",

doi = "10.1212/NXI.0000000000000378",

language = "English",

volume = "4",

number = "5",

}

TY - JOUR

T1 - Glucocorticoid-associated blood glucose response and MS relapse recovery

AU - Goldman, Myla D.

AU - Koenig, Scott

AU - Engel, Casey

AU - McCartney, Christopher R.

AU - Sohn, Min Woong

PY - 2017

Y1 - 2017

N2 - To determine the relationship between MS relapse recovery and blood glucose (BG) response to IV methylprednisolone (IVMP) treatment. Methods: We retrospectively identified 36 patients with MS admitted for IVMP treatment of acute relapse who had adequate data to characterize BG response, relapse severity, and recovery. The relationship between glucocorticoid-associated nonfasting BG (NFBG) and relapse recovery was assessed. Results: Highest recorded nonfasting BG (maximum NFBG [maxNFBG]) values were significantly higher in patients with MS without relapse recovery compared with those with recovery (271 ± 68 vs 209 ± 48 mg/dL, respectively; p = 0.0045). After adjusting for relapse severity, MS patients with maxNFBG below the group median were 6 times (OR = 6.01; 95% CI, 1.08-33.40; p = 0.040) more likely to experience relapse recovery than those with maxNFBG above the group median. In a multiple regression model adjusting for age, sex, and relapse severity, a 1-mg/dL increase in the maxNFBG was associated with 4.5% decrease in the probability of recovery (OR = 0.955; 95% CI, 0.928-0.983; p = 0.002). Conclusions: These findings suggest that higher glucocorticoid-associated NFBG values in acutely relapsing patients with MS are associated with diminished probability of recovery. This relationship could reflect steroid-associated hyperglycemia and/or insulin resistance, defects in non-steroid-associated (e.g., prerelapse) glucose metabolism, or both. This study included only those admitted for an MS relapse, and it is this subset of patients for whom these findings may be most relevant. A prospective study to evaluate glucose regulation and MS relapse recovery in a broader outpatient MS population is under way.

AB - To determine the relationship between MS relapse recovery and blood glucose (BG) response to IV methylprednisolone (IVMP) treatment. Methods: We retrospectively identified 36 patients with MS admitted for IVMP treatment of acute relapse who had adequate data to characterize BG response, relapse severity, and recovery. The relationship between glucocorticoid-associated nonfasting BG (NFBG) and relapse recovery was assessed. Results: Highest recorded nonfasting BG (maximum NFBG [maxNFBG]) values were significantly higher in patients with MS without relapse recovery compared with those with recovery (271 ± 68 vs 209 ± 48 mg/dL, respectively; p = 0.0045). After adjusting for relapse severity, MS patients with maxNFBG below the group median were 6 times (OR = 6.01; 95% CI, 1.08-33.40; p = 0.040) more likely to experience relapse recovery than those with maxNFBG above the group median. In a multiple regression model adjusting for age, sex, and relapse severity, a 1-mg/dL increase in the maxNFBG was associated with 4.5% decrease in the probability of recovery (OR = 0.955; 95% CI, 0.928-0.983; p = 0.002). Conclusions: These findings suggest that higher glucocorticoid-associated NFBG values in acutely relapsing patients with MS are associated with diminished probability of recovery. This relationship could reflect steroid-associated hyperglycemia and/or insulin resistance, defects in non-steroid-associated (e.g., prerelapse) glucose metabolism, or both. This study included only those admitted for an MS relapse, and it is this subset of patients for whom these findings may be most relevant. A prospective study to evaluate glucose regulation and MS relapse recovery in a broader outpatient MS population is under way.

UR - http://www.scopus.com/inward/record.url?scp=85029028732&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029028732&partnerID=8YFLogxK

U2 - 10.1212/NXI.0000000000000378

DO - 10.1212/NXI.0000000000000378

M3 - Article

AN - SCOPUS:85029028732

VL - 4

JO - Neurology: Neuroimmunology and NeuroInflammation

JF - Neurology: Neuroimmunology and NeuroInflammation

IS - 5

M1 - 378

ER -

Glucocorticoid-associated blood glucose response and MS relapse recovery

Abstract

Bibliographical note

Funding

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this