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Jerry H. Gurwitz, MD; Rhonda L. Bohn, MPH; Robert J. Glynn, ScD; Mark Monane, MD, MS; Helen Mogun, MS; Jerry Avorn, MD

Arch Intern Med. 1994;154(1):97-101.

Abstract
Purpose
To quantify risk for the occurrence of hyperglycemia requiring initiation of hypoglycemic therapy in patients treated with oral glucocorticoids.

Patients and Methods
A case-control study of enrollees in the New Jersey Medicaid program 35 years of age or older. The 11 855 case patients had newly initiated treatment with a hypoglycemic agent (oral or insulin) between 1981 and 1990. The 11 855 controls represented a random sample of other Medicaid enrollees.

Results
In patients using oral glucocorticoids, the estimated relative risk for development of hyperglycemia requiring treatment was 2.23 (95% confidence interval, 1.92 to 2.59) as compared with nonusers. Risk increased with increasing average daily steroid dose, in hydrocortisone-equivalent milligrams; the odds ratio was 1.77 for 1 to 39 mg/d, 3.02 for 40 to 79 mg/d, 5.82 for 80 to 119 mg/d, and 10.34 for 120 mg/d or more. The estimated effects persisted after adjustment for a variety of potentially confounding demographic, health service utilization, and medication use variables.

Conclusion
The findings of this population-based study quantify the risk of developing hyperglycemia requiring hypoglycemic therapy after oral glucocorticoid use. The magnitude of risk increases substantially with increasing glucocorticoid dose. These findings demonstrate the utility of large-scale health claims databases in defining the risk of important adverse drug effects.

(Arch Intern Med. 1994;154:97-101)

Author Affiliations
From the Program for the Analysis of Clinical Strategies, Gerontology Division (Drs Gurwitz, Monane, and Avorn, and Mss Bohn and Mogun), and the Division of Preventive Medicine (Dr Glynn), Department of Medicine, Brigham and Women's Hospital, Boston, Mass; and the Geriatric Research and Training Center, Harvard Medical School, Boston (Drs Gurwitz, Glynn, Monane, and Avorn and Mss Bohn and Mogun).

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