Steroids decrease diabetic risk in Glutamic Acid Decarboxylase-65 (GAD65) neurological autoimmunity: a retrospective cohort study

Steroids decrease diabetic risk in Glutamic Acid Decarboxylase-65 (GAD65) neurological autoimmunity: a retrospective cohort study

BackgroundIt has become dogma that steroids should be avoided in patients with GAD65 neurological autoimmunity because of perceived increase in diabetes risk. Little prior data is available on the clinical and serological predictors of diabetes development.Methods196 Mayo Clinic patients with high-t...

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Bibliographic Details
Published in:Journal of neurology, neurosurgery and psychiatry Vol. 94; no. Suppl 1; p. A32
Main Authors: Mulligan, MD, Budhram, A, Sechi, E, Flanagan, E P, Dubey, D, Zekeridou, A, McKeon, A, Zalewski, N L, Pittock, S J, Pittock ST
Format: Journal Article
Language:English
Published: London BMJ Publishing Group LTD 01-11-2023
Subjects:
Cohort analysis
Diabetes
Immunotherapy
Steroids
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Summary:BackgroundIt has become dogma that steroids should be avoided in patients with GAD65 neurological autoimmunity because of perceived increase in diabetes risk. Little prior data is available on the clinical and serological predictors of diabetes development.Methods196 Mayo Clinic patients with high-titre (>20 nmol/L in serum; normal reference range ≤0.02nmol/L) GAD65 antibodies who had a HbA1c measured or medication list available at least 1 year post-initial therapy were identified (2003-2018).ResultsDiabetes was diagnosed in 86 patients (43.9%): assigned T1 status in 63 (32.3%) and type 2 status in 22 patients (11.3%). 43 (50.6%) diabetes cases occurred after neurological onset. If patients did not have diabetes prior to neurological onset, diabetes diagnosis occurred a median of 5 years later in 39.1% of patients. Of those with a diagnosis of type 2 diabetes, 45% required insulin (p= 0.01). Steroids reduced the risk of diagnosis of diabetes (p= 0.046). After stopping immunotherapy, the probability (0.69) of neu- rological relapse is high (p= 0.002).ConclusionsOver half of diabetes cases occur after neurological onset. Steroids reduce, not increase, the risk of diabetes in GAD65 neurological disease. Consideration should be given to continuing mainte- nance treatment as risk of relapse after stopping immunotherapy is high.
ISSN:0022-3050
1468-330X
DOI:10.1136/JNNP-2023-ABN.96