Abstract

Purpose: Demonstrate use of a DPP-4 inhibitor to manage steroid-induced hyperglycemia in an older adult with steroid-induced hyperglycemia.

Summary: Guidelines recommend insulin for the management of steroid-induced hyperglycemia. Oral options are often more favorable given the ability to avoid administration of insulin injections and an increased risk of hypoglycemia, however supporting evidence is lacking. An 86- year-old, white male with Type 2 Diabetes Mellitus, previously well controlled on metformin mono therapy, had an A1C increase of 2% after 3 months of oral prednisone. Saxagliptin 5mg daily was added, after 4 months of dual oral therapy, the patients A1C returned to baseline; a decrease from 10.1% to 7.8%. During this period, the patient was maintained on an average dose of prednisone 10mg daily and no significant changes were made to diet or exercise habits.

Conclusion: Conclusion:

Key Points

a. Current guidelines suggest the use of insulin for the management of steroid-induced hyperglycemia which may be less favorable for older adults.

b. DPP-4 inhibitors have a glucose dependent mechanism of action and low risk for hypoglycemia making them a preferable option in older adults.

c. DPP-4 inhibitors have demonstrated efficacy for the management of steroid-induced hyperglycemia when used in conjunction with metformin.