Glucocorticoid-induced hyperglycaemia

This thesis contains studies on current practice, clinical implications and treatment of excess glucocorticoid receptor (GCR) stimulation, with a focus on glucocorticoid-induced hyperglycaemia (GCIH).
Chapter 1 is a general introduction to the glucocorticoid hormone. In chapter 2, we have investigated attitudes of clinicians towards the problem of GCIH.
In chapter 3, we explored implications of GCIH for antineoplastic chemotherapy through a systematic review of preclinical studies. We were not able to conclude the effect of hyperglycaemia on the efficacy of chemotherapy in human patients, but the results suggested that very high glucose levels should be prevented.
In chapter 4 and 5, we studied treatment of GCIH. We observed that once daily intermediate-acting insulin resulted in better glycaemic control than the sliding scale insulin regimen during antineoplastic chemotherapy (chapter 4). We studied dapagliflozin, an agent that induces urinary glucose excretion in a RCT in acute exacerbation of COPD but found no difference in glycaemic control.
Chapter 6 covers the GCR. We conclude that genetic variants of the GCR are of minor relevance for the onset of type 2 diabetes and the course of established type 2 diabetes.
In chapter 7 we studied the use of glucocorticoid medication in persons that underwent roux-y gastric bypass surgery to induce weight-loss. Weight loss and rate of postoperative complications was not different between exposed and non-exposed individuals.