Glucose intolerance and diabetes mellitus in ulcerative colitis: Pathogenetic and therapeutic implications

Table 1 Common shared complications in diabetes mellitus and ulcerative colitis

Neurological

Distal symmetric polyneuropathy (50% in DM and 0%-39% in UC)

Hepatobiliary

Cholelithiasis (20%-30% in DM, only after colectomy in UC)

Hepatic steatosis

Non alcoholic fatty liver disease

Osteo-articular complications

Osteoporosis

Vascular complications

Venous thrombosis (with ketoacidosis in DM, with active disease or surgery in UC)

Post-operative complications

Anastomotic dehiscence

Infections

Non-infectious complications

DM: Diabetes mellitus; UC: Ulcerative colitis.

Table 2 Predictive risk factors for the development of diabetes mellitus and hyperglycemia in ulcerative colitis patients treated with corticosteroids

High dose of corticosteroids

Long duration of corticosteroids therapy

Advanced age

High body mass index

Family history of diabetes

Previous gestational diabetes

Table 3 Management of active severe ulcerative colitis in diabetic patients treated with corticosteroids

Disease monitoring	Disease treatment
Regular monitoring of blood glucose level Regular monitoring of disease activity (e.g., Disease Activity Index) Plain abdominal X-ray	Rehydration with saline solution Correction of blood glucose levels Treatment of hypokaliemia Treatment of hypomagnesaemia
Dosage of: C-reactive protein Blood cell count Electrolytes Anion gap Osmolality Serum creatinine levels Ketones Urinalysis Blood gas analysis	Consider alternative treatments Iv cyclosporine A (4 mg/d) Infliximab (5 mg/kg or 10 mg/kg) Adalimumab (160 mg/80 mg/40 mg eow) Tacrolimus Leucocytapheresis Other therapies (vedolizumab, visilizumab, abatacept, tofacitinib)