1625-P: Characteristics of the Oral Glucocorticoid-Induced Diabetes Mellitus (GIDM) in Miners with Compromised Lung Function in a Limited Resource Setting

Oral glucocorticoids are efficacious for treating respiratory diseases but with a high risk to induce diabetes. We analysed a subset of patients from the Redi iron ore miners from a rural setting (n=25,500), who were newly diagnosed diabetics on extensive chronic methylprednisolone equivalent glucocorticoid dose of ≥4 mg/day for at least 3 months for treatment of respiratory ailments due to occupational hazard (n=1100, males= 660, females=4400). t test and Fisher's exact test were used for the statistical analysis. The mean HbA1c was 7.1% (SD ± 0.62, 95% CI 7-7.3), mean age 51 years (SD ± 14, 95% CI 48 - 54), mean BMI 26 kg/m²(SD ± 3.6, 95% CI 25 - 27), mean Fasting Plasma Glucose 146 mg/dl (SD ± 49, 95% CI 136-155) mg/dl, mean Post Prandial Glucose 207mg/dl (SD±74, 95% CI 192 - 221). HbA1c at diagnosis in the relatively low risk group (young - normal weight group with age < 40 years, BMI <25 kg/m²) (n=231) was less than the high risk group (older - overweight with age > 40 years, BMI >25 kg/m²) (n=616); mean HbA1c 6.7% (SD±0.33, 95% CI 6.5 - 6.8) vs. mean HbA1c 7.3% (SD±0.65, 95% CI 7.1 - 7.5) (p<0.0001). There was a significant correlation for a high propensity of relatively younger <50 years (n=506) and near normal weight people with BMI < 26 kg/m² (n=594) to develop GIDM (p=0.006). We observed that high incidence of GIDM (4.31%) is an alarmingly harmful problem which has pronounced comorbid implications, especially in the younger, economically productive population in the limited resource setting. The health care professionals need to be educated to limit the use of glucocorticoids to inhalational therapy with minimal systemic effects. Specific pathophysiological approach to address the steroid induced insulin resistance in this population, makes the treatment of GIDM difficult, which calls for action to limit the mining activities and mitigate the risk of chronic complications due to diabetes.