medwireNews: Australian research shows that in older patients with chronic obstructive pulmonary disease (COPD) and comorbid diabetes, high-dose corticosteroids are associated with an increased risk for diabetes-related complications, regardless of how they are administered.
"The results of this study suggest that, when they are necessary to use, corticosteroids should be used in their minimally effective dose for older patients with diabetes and COPD," say authors Gillian Caughey (University of South Australia, Adelaide) and colleagues.
Using a competing risk analysis, they found that among 1077 patients with comorbid COPD and diabetes, those who took high-dose corticosteroids (≥0.83 defined daily dose [DDD]/day) had a 94% greater risk for hospitalization for diabetes complications during their first year of antidiabetic treatment, relative to those who were not taking corticosteroids.
And this was not influenced by the type of administration when the authors stratified the results according to whether patients received inhaled steroids only, oral steroids only, or both.
Additionally, they note a dose-dependent effect of steroids on the risk for complications, although this was not statistically significant at doses lower than 0.83 DDD/day.
The study included patients aged a median of 80 years, of whom 7.1% of steroid users and 6.3% of nonusers had a hospitalization for diabetes complications during the first year of the study.
Noting that older patients and those with comorbidities are often excluded from clinical trials, Caughey and colleagues say that their findings "provide an insight into potential safety concerns of corticosteroid use in a real-world setting for the treatment of COPD in patients with comorbid diabetes, where both oral and systemic corticosteroids are used."
They write in Diabetes Care: "This highlights the potential for longer-term adverse effects of higher doses of both oral and systemic corticosteroids on diabetes complications in older patients."
Caughey and colleagues conclude that high-dose corticosteroids should be avoided wherever possible in COPD patients with comorbid diabetes. Additionally, physicians should closely monitor blood glucose and review inhaled corticosteroid therapy efficacy within 4-8 weeks, regardless of dosage, they recommend.
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