A case of type 2 diabetes in which topical glucocorticoid therapy leaded to a deterioration in glycemic control

Abstract

A 71-year-old woman had been diagnosed with type 2 diabetes and treated by diet therapy and oral diabetes medicine at 56 years of age. She developed a generalized itching rash two years prior to admission and was administered topical class II steroids by the Department of Dermatology at her local hospital. Although her HbA1c level was approximately 7 %, she was admitted to her local hospitals Department of Dermatology due to aggravation of the itching rash. While hospitalized, topical steroids were changed to class I agents, and she was discharged after approximately three weeks of treatment. The day after being discharged, she visited our department, where it was found that her casual blood glucose level was high (803 mg/dL), leading to her being admitted once again. Upon inspection at admission, the involvement of type 1 diabetes onset, malignant tumors, and infection were ruled out and the topical steroids were deemed to have deteriorated her glycemic control. The local administration of topical steroids rarely affects the internal organs due to its low absorption efficiency. However, it is necessary to be alert for deteriorating glycemic control when using high-titer topical steroids in individuals with a dysfunctional skin barrier, as shown in this study.