GLP-1 Agonists Show Promise for Managing Steroid-Induced Diabetes

Glucocorticosteroids (GCs) are widely used for autoimmune, inflammatory, and neoplastic diseases, but they often lead to significant metabolic side effects, including increased insulin resistance, impaired pancreatic β-cell function, and weight gain. These effects can result in steroid-induced hyperglycemia (SIH) and steroid-induced diabetes (SID), which elevate the risk of complications such as infections and prolonged hospitalization. While intensive insulin therapy is the current standard, this review evaluates the efficacy and safety of GLP-1 receptor agonists (GLP-1 RAs) as a potential therapeutic alternative for SIH and SID.

The review found that GLP-1 RAs consistently improved glycemic control in patients with SIH/SID. Studies showed significant reductions in HbA1c levels, often by 0.8% to 1.5%, and fasting glucose levels by 30-50 mg/dL compared to placebo or conventional therapy. > GLP-1 RAs demonstrated superior efficacy in mitigating weight gain associated with steroid use, with patients experiencing an average weight loss of 2-5 kg over several months, contrasting with weight gain in control groups. Furthermore, GLP-1 RAs improved pancreatic β-cell function and reduced insulin resistance, leading to a 20-40% decrease in exogenous insulin requirements for some patients. These benefits were observed across various GLP-1 RA types, suggesting a class effect and a more comprehensive metabolic improvement than insulin alone.