विवरण
Prednisone causes dose-dependent hyperglycaemia that can overcome metformin's glucose-lowering capacity, resulting in poorly controlled blood glucose, particularly postprandially.
तंत्र
Glucocorticoids induce hepatic insulin resistance and impair peripheral glucose uptake, primarily raising postprandial glucose; metformin mainly acts on fasting hepatic glucose output and cannot fully counteract the pronounced postprandial effect of prednisone.
नैदानिक महत्व
Steroid-induced diabetes is common (incidence 20–50% with significant prednisone doses); metformin monotherapy is often insufficient and additional agents (sulfonylurea, insulin) are required.
प्रबंधन
Monitor blood glucose more frequently when starting or dose-escalating prednisone; add short-acting insulin or a sulfonylurea if HbA1c or glucose targets are not met on metformin alone; reduce additional agents when steroid is tapered.