New-onset iatrogenic diabetes in a teenager with ulcerative colitis – an additional challenge
Keywords:
diabetes, glucocorticoids, immunosuppression, inflammatory bowel disease, mycophenolate mofetilAbstract
Introduction: Glucocorticoids (GC) are long-established agents for the induction of remission in inflammatory bowel disease (IBD). Hyperglycemia is a known complication of GC, and this risk increases when combined with immunosuppressive treatments, particularly with mycophenolate mofetil (MMF). In patients with IBD, there is insufficient information regarding the adverse outcomes of using both therapies concerning hyperglycemia and new-onset diabetes.
Case Report: A 13-year-old girl with ulcerative colitis (UC), two years after diagnosis, started MMF along with GC. She developed polydipsia and polyuria one week earlier. Follow-up laboratory workup revealed hyperglycemia (696 mg/dL), without ketosis or acidosis, a baseline HbA1c of 7.4%. Insulin treatment was initiated, MMF was suspended, and GC weaning was attempted again. New-onset diabetes complicated the management of a previously diagnosed depressive and anxiety disorder. On follow-up, insulin needs progressively decreased, and insulin was discontinued after five months.
Conclusion: The concomitant use of GC and MMF might have posed a cumulative risk. This case highlights the importance of a multidisciplinary team when establishing a healthcare plan for an adolescent with multifactorial chronic disease burden.
Downloads
References
Maconi G, Furfaro F, Sciurti R, Bezzio C, Ardizzone S, Franchis R. Glucose intolerance and diabetes mellitus in ulcerative colitis: pathogenetic and therapeutic implications.” World J Gastroenterol 2014;20(13):3507-3515.
Kappelman M, Galanko J, Porter C, Sandler R. Association of paediatric inflammatory bowel disease with other immune-mediated diseases. Arch Dis Child 2011;96:1042–1046.
Gomollón F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay J, et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 1: Diagnosis and Medical Management, J Crohns Colitis. 2017;11(1):3-25.
Ford A, Bernstein C, Khan K, Abreu M, Marshall J, Talley N, et al. Glucocorticosteroid therapy in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2011;106(4):590-600.
McDonnell M, Harris_R, Borca_F, Mills T, Downey L, Dharmasiri S, et al. High incidence of glucocorticoid-induced hyperglycaemia in inflammatory bowel disease: metabolic and clinical predictors identified by machine learning. BMJ Open Gastro 2020;7:e000532.
Tamez-Pérez H, Quintanilla-Flores D, Rodríguez-Gutiérrez R, González-González J, Tamez-Peña A. Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review. World J Diabetes. 2015;6(8):1073-1081.
Hwang JL, Weiss RE. Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment. Diabetes Metab Res Rev. 2014;30(2):96-102.
Galindo R, Wallia A. Hyperglycemia and Diabetes Mellitus Following Organ Transplantation. Curr Diab Rep. 2016;16(2):14.
Abdel-Razaq W, Ismail W, Anazi A, Alissa A. The risk of hyperglycemia associated with the use of prescribed medications. Int J Pharm Sci Res. 2017;8(9):3991‑3999.
Knop-Chodyla K, Piasecka Z, Kochanowska-Mazurek A, Głaz A, Wesołek E, Rudziki G. Steroid therapy in patients with inflammatory bowel disease complicating diabetes diagnosis. Qual Sport. 2024;18:51010.
de Wit M, Gajewska KA, Goethals ER, McDarby V, Zhao X, Hapunda G, et al. ISPAD Clinical Practice Consensus Guidelines 2022: Psychological care of children, adolescents and young adults with diabetes. Pediatr Diabetes. 2022 Dec;23(8):1373-1389. doi: https://doi.org/10.1111/pedi.13428.
Sang MM, Sun ZL, Wu TZ. Inflammatory bowel disease and diabetes: Is there a link between them? World J Diabetes 2022; 13(2): 126-128.
Turner D, Ruemmele FM, Orlanski-Meyer E, Griffiths AM, de Carpi JM, Bronsky J, et al. Management of Paediatric Ulcerative Colitis, Part 2: Acute Severe Colitis-An Evidence-based Consensus Guideline From the European Crohn‘s and Colitis Organization and the European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Aug;67(2):292-310. doi: https://doi.org/10.1097/MPG.0000000000002036.
Turner D, Ruemmele FM, Orlanski-Meyer E, Griffiths AM, de Carpi JM, Bronsky J, et al. Management of Paediatric Ulcerative Colitis, Part 1: Ambulatory Care-An Evidence-based Guideline From European Crohn‘s and Colitis Organization and European Society of Paediatric Gastroenterology, Hepatology and Nutrition. J Pediatr Gastroenterol Nutr. 2018 Aug;67(2):257-291. doi: 10.1097/MPG.0000000000002035. Erratum in: J Pediatr Gastroenterol Nutr. 2020 Dec;71(6):794. doi: https://doi.org/10.1097/MPG.0000000000002967.
Tosur M, Viau-Colindres J, Astudillo M, Redondo MJ, Lyons SK. Medication-induced hyperglycemia: pediatric perspective. BMJ Open Diabetes Res Care. 2020 Jan;8(1):e000801. doi: https://doi.org/10.1136/bmjdrc-2019-000801.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Cristiana Costa, Ana Laura Fitas, Sofia Bota, Isabel Afonso, Catarina Diamantino, Lurdes Lopes
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in the Birth and Growth Medical Journal are Open Access and meet the requirements of funding agencies and academic institutions. Third-party use of published content is permitted under the terms of the Creative Commons Attribution-NonCommercial (CC BY-NC) license. It is the responsibility of authors to obtain permission for reproducing figures, tables, or other materials from previously published works.
Authors must submit a Conflict of Interest statement and an Authorship Form together with their manuscript. A confirmation email will be sent to the corresponding author upon receipt of the submission. Authors are also permitted to deposit their articles in institutional or personal repositories, provided that the original publication in the Birth and Growth Medical Journal is clearly indicated and the terms of the Creative Commons license are respected.
