Islet-cell dysfunction induced by glucocorticoid treatment: potential role for altered sympathovagal balance?

Abstract

AimGlucocorticoids impair glucose tolerance by inducing insulin resistance. We investigated the dose-dependent effects of glucocorticoid treatment on islet-cell function in healthy males and studied the role of the autonomic nervous system. Design and MethodsA randomized, placebo-controlled, double-blind, dose–response intervention study was conducted in 32 healthy males (age: 21±2years; BMI: 21.9±1.7kg/m2). Participants were allocated to prednisolone 7.5mg once daily (n=12), prednisolone 30mg once daily (n=12), or placebo (n=8) for two weeks. Beta-cell function was measured by hyperglycemic clamp with arginine stimulation, glucagon levels were measured following a standardized meal test. ResultsWe found that prednisolone treatment dose-dependently reduced C-peptide secretion following arginine stimulation on top of hyperglycemia (ASI-iAUCCP): −2.8 (−5.2;0.2) and −3.1 (−8.8; −1.0) nmolL−1min−1 for prednisolone 7.5mg and prednisolone 30mg, respectively (P=0.035 vs. placebo). Fasting glucagon levels increased dose-dependently (vs. placebo; P=0.001), whereas postprandial glucagon levels were only increased by prednisolone 30mg. Changes in parasympathetic activity related with changes in fasting glucose levels (r=−0.407; P=0.03) and showed a trend towards correlation with fasting glucagon concentrations (r=−0.337; P=0.07). The change in sympathovagal balance was inversely related to ASI-iAUCCP (r=−0.365; P=0.05). ConclusionWe conclude that in addition to inducing insulin resistance, prednisolone treatment dose-dependently impaired islet-cell function. Altered sympathovagal balance may be related to these effects.