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Safer steroid use in people at risk or with diabetes

Project summary

Using steroids can increase the risk of developing a specific type of diabetes called steroid diabetes. It can also lead to higher blood sugar levels in people with other types of diabetes. Dr Katharine Lazarus will explore if a type 2 diabetes medication, called liraglutide, could help to lower this risk and lower blood sugar levels. This study could pave the way for a safer steroid use for people with or at risk of diabetes.

Background to research

Steroids are a type of medication used to treat conditions like asthma, arthritis, and infections. Around 1 million people in the UK take them frequently. Steroids can switch off a protein, called AMPK, which controls how the body changes food to energy. This can lead to raised blood sugar levels and a form of diabetes, called steroid diabetes. 

We know up to 40% of steroid users can develop steroid diabetes. It is currently treated with insulin, or a drug called gliclazide. But these treatments in people with steroid diabetes can come with a risk of dangerously low blood sugar levels. They can also cause people treated with steroids to gain more weight. This means it’s vitally important to find new ways to treat steroid diabetes. 

Liraglutide is a drug used to treat type 2 diabetes. It works to switch AMPK back on, which can bring blood sugar levels down. It can also help to reduce appetite. But we don’t know if it can lower the risk of developing steroid diabetes. Or if it could help to better treat people with diabetes who are taking steroids.  

Research aims

Dr Katharine Lazarus and her team want to test if liraglutide could help to improve blood sugar levels in people taking steroids. They’ll recruit people with prediabetes, who have higher than usual blood sugar levels and are at high risk of developing type 2 diabetes, and people already living with type 2 diabetes.  

The team will give them a common steroid treatment for seven days. During this time, volunteers will also be treated with one of the three options: (1) liraglutide, (2) another type 2 diabetes drug called metformin (3) a harmless dummy tablet called a placebo. 

The team will monitor participants’ blood sugar levels throughout the study. They’ll also check how well liraglutide can lower blood sugar levels after eating a meal, compared with metformin or a placebo. They’ll carry out this test both before and after the 7-day steroid treatment. 

They’ll also measure how sensitive the body is to insulin in a smaller group of participants. 

Lastly, the team will take a tiny sample of fat and muscle tissue from some of the participants and look for changes to how AMPK is working.  

Potential benefit to people with diabetes

This research could lay the groundwork for an add-on treatment to help people at risk of steroid diabetes, or with type 2 diabetes and taking steroids, to better manage their blood sugar levels. Since liraglutide is already in use to treat type 2 diabetes, it could be a quick, new solution to lower the risk of people treated with steroids from developing steroid diabetes while avoiding side-effects of current treatments. 

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