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. 2024 May 31;16(5):e61456.
doi: 10.7759/cureus.61456. eCollection 2024 May.

Impact of Glucocorticoid Replacement Therapy on Nocturnal Hypoglycemia in Adrenal Insufficiency: An Analysis of Multiple Case Studies

Ken Kanazawa  1 , Mai Hijikata  1 , Shinichiro Koga  1 , Koichiro Kuwabara  1
Affiliations

Impact of Glucocorticoid Replacement Therapy on Nocturnal Hypoglycemia in Adrenal Insufficiency: An Analysis of Multiple Case Studies

Ken Kanazawa et al. Cureus. .

Abstract

Background and aim: Adrenal insufficiency (AI) is a hormonal disorder characterized by insufficient glucocorticoid production. Nocturnal hypoglycemia (NH) occurs in patients with AI. However, the effect of glucocorticoid replacement therapy (GCRT) on AI and NH remains unclear. This study aimed to investigate the relationship between AI and NH by evaluating the impact of GCRT on NH in patients newly diagnosed with AI.

Methods: The present study was conducted between October 2018 and December 2022 at the Department of Diabetes, Metabolism and Endocrinology of the Tokyo Rosai Hospital, Japan. In total, 15 patients aged ≥18 years with newly diagnosed AI or NH were included in this study. The NH frequency was measured using continuous glucose monitoring (CGM). The primary outcome was the change in NH frequency before and after the GCRT intervention.

Results: GCRT significantly decreased NH frequency. Severe NH frequency and minimum nocturnal glucose levels changed significantly while fasting blood glucose and glycated hemoglobin levels did not change significantly. GCRT intervention improved CGM profiles' time below range, time in range, and average daily risk range.

Conclusions: The present study suggests that GCRT can help newly diagnosed patients with AI manage NH. These findings show that CGM can detect NH in patients with newly diagnosed AI, determine the optimal GCRT dosage, and hence prevent an impaired quality of life and even serious adverse effects in these patients. Further large multicenter studies should validate these findings and delve deeper into the mechanistic link between AI and NH.

Keywords: adrenal insufficiency; continuous glucose monitoring; glucocorticoids; nocturnal hypoglycemia; quality of life.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. The Institutional Review Board of Tokyo Rosai Hospital issued approval REC No.05-03. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Flow diagram showing enrollment, study intervention, and follow-up of the study participants
Freestyle Libre Pro monitor (Abbott, Tokyo, Japan). NH: nocturnal hypoglycemia; AI: adrenal insufficiency; GCRT: glucocorticoid replacement therapy
Figure 2
Figure 2. Change in frequency of nocturnal hypoglycemia and severe nocturnal hypoglycemia pre- and post-glucocorticoid replacement therapy
(a) The frequency of NH (<70 mg/dL, 0–6 a.m.) before and after GCRT. (b) SNH frequency (<54 mg/dL, 0–6 a.m.) before and after GCRT. *Comparison of NH or SNH frequencies before and after GCRT using Student's t-test. NH: nocturnal hypoglycemia; SNH: severe nocturnal hypoglycemia; GCRT: glucocorticoid replacement therapy
See this image and copyright information in PMC

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