Dual-release hydrocortisone helps improve insulin secretion, sensitivity in prediabetics
Long-term treatment with dual-release hydrocortisone (DR-HC) appears to produce favourable effects on insulin secretion and sensitivity in patients with prediabetes, according to a study. The treatment also confers benefits for metabolic and anthropometric parameters.
Researchers performed a retrospective analysis of 49 patients (13 with primary and 36 with secondary adrenal insufficiency [AI]) who were on conventional glucocorticoid treatment at baseline and switched to DR-HC for 36 months. Data examined were clinical and metabolic parameters (including visceral adiposity index [VAI]) and insulin secretion and sensitivity indexes (fasting insulinaemia, AUC2h insulinaemia, oral disposition index [DIo] and ISI-Matsuda).
Of the patients, 24 patients had AI-prediabetes (impaired fasting glucose, impaired glucose tolerance and the combination) and 25 had AI-normal glucose tolerance (NGT). Patients in both the AI-prediabetes and AI-NGT groups exhibited a significant decrease in body mass index (p<0.001 and p=0.017, respectively) and in HbA1c (p=0.001 and p=0.034, respectively), as well as a significant increase in high-density lipoprotein cholesterol (HDL-C; p=0.043 and p=0.036, respectively).
Moreover, there was a significant decrease in insulinaemia (p=0.014), AUC2h insulinaemia (p=0.038) and VAI (p=0.001), in addition with a significant increase in DIo (p=0.041) and ISI-Matsuda (p=0.038).
“[T]he improvement in insulin secretion in patients with prediabetes is demonstrated by the reduction of insulinaemia and the increase in insulin secretion relative to insulin resistance (DIo). Indeed, DIo, which expresses the ability of β-cells to adequately compensate insulin resistance through increased insulin secretion, is a predictable factor of diabetes development in adults and for this reason it may be useful to evaluate this risk related to overtreatment with glucocorticoid in AI patients,” researchers said.
“On the other hand, ISI-Matsuda is a useful tool to evaluate the insulin resistance degree of the whole body,” they continued. This tool is derived from the oral glucose tolerance test and closely correlates with the M-value of the euglycaemic hyperinsulinaemic clamp, which represents the gold standard of insulin sensitivity measurement. [Diabetes Care 2010;33:920-922]