The difference between steroid diabetes mellitus and type 2 diabetes mellitus: a whole-body 18 F-FDG PET/CT study
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ORIGINAL ARTICLE
The difference between steroid diabetes mellitus and type 2 diabetes mellitus: a whole‑body 18F‑FDG PET/CT study Qingqing Zhao1 · Jinxin Zhou1 · Yu Pan1 · Huijun Ju1 · Liying Zhu1 · Yang Liu1 · Yifan Zhang1 Received: 6 May 2020 / Accepted: 26 June 2020 © The Author(s) 2020
Abstract Aims Steroid diabetes mellitus (SDM) is a metabolic syndrome caused by an increase in glucocorticoids, and its pathogenesis is unclear. 18F-FDG PET/CT can reflect the glucose metabolism of tissues and organs under living conditions. Here, PET/ CT imaging of SDM and type 2 diabetes mellitus (T2DM) rats was used to visualize changes in glucose metabolism in the main glucose metabolizing organs and investigate the pathogenesis of SDM. Methods SDM and T2DM rat models were established. During this time, PET/CT imaging was used to measure the %ID/g value of skeletal muscle and liver to evaluate glucose uptake. The pancreatic, skeletal muscle and liver were analyzed by immunohistochemistry. Results SDM rats showed increased fasting blood glucose and insulin levels, hyperplasia of islet α and β cells, increased FDG uptake in skeletal muscle accompanied by an up-regulation of PI3Kp85α, IRS-1, and GLUT4, no significant changes in liver uptake, and that glycogen storage in the liver and skeletal muscle increased. T2DM rats showed atrophy of pancreatic islet β cells and decreased insulin levels, significantly reduced FDG uptake and glycogen storage in skeletal muscle and liver. Conclusions The pathogenesis of SDM is different from that of T2DM. The increased glucose metabolism of skeletal muscle may be related to the increased compensatory secretion of insulin. Glucocorticoids promote the proliferation of islet α cells and cause an increase in gluconeogenesis in the liver, which may cause increased blood glucose. Keywords Steroid diabetes mellitus · Glucocorticoids · Pathogenesis · 18F-FDG · PET/CT
Background Glucocorticoids are of key clinical use, due to their effective anti-inflammatory, anti-allergic, and immunosuppressive effects [1]. However, excessive glucocorticoids (endocrine corticosteroid secretion or exogenous glucocorticoid intake) in the body often leads to glucose metabolism disorders, a condition termed steroid diabetes mellitus (SDM). The occurrence of SDM seriously affects the survival rate and quality of life of patients [2]. At present, domestic and foreign studies generally classify SDM as type 2 diabetes mellitus (T2DM). It is thought Managed by Massimo Federici. * Yifan Zhang [email protected] 1
Department of Nuclear Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 197, Ruijin 2nd Road, Shanghai 200025, China
that the occurrence of SDM is related to the damage of islet β cell function, and insulin resistance in major glucose metabolism organs, such as skeletal muscle, liver, and fat caused by glucocorticoids [3, 4]. However, clinical diagnosis and treatment has revealed that SDM patients differ from T2DM patients, and some SDM patients can return to normal blood
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