Inhaled corticosteroids modestly increase risk for Type 2 diabetes
MedWire News: Patients with respiratory disease treated with inhaled corticosteroids have a modestly increased risk for Type 2 diabetes or progression of existing diabetes, say researchers.
The team notes that the patients with the highest risk were those taking higher corticosteroid doses, such as those prescribed for the treatment of chronic obstructive pulmonary disease (COPD).
Writing in the American Journal of Medicine, Samy Suissa (McGill University, Montreal, Quebec, Canada) and colleagues report the results from a study of 388,584 patients, aged 65.8 years on average, treated for respiratory disease (mostly asthma and COPD) during 1990-2005.
The cohort was followed-up for 5 years, during which time 30,167 of 301,096 patients without diabetes at baseline developed new-onset diabetes (incidence rate [IR]=14.2/1000/year) and 2099 of 20,763 Type 2 diabetics being treated with oral antihyperglycemic agents progressed to insulin therapy (IR=19.8/1000/year). New-onset diabetes was defined by first-time treatment with antidiabetic medication.
Corticosteroid use was measured overall versus no use and was also divided into low, moderate, and high use, according to fluticasone equivalents of less than 500, 500-999, and 1000 µg/day or more, respectively.
The researchers found that compared with no use, any corticosteroid use increased the adjusted rate ratio for new-onset diabetes by a significant 34%. When divided by dose, adjusted rate ratios were increased by a significant 18%, 30%, and 64% in the low-, moderate-, and high-dose groups, respectively.
In a similar fashion, any use of corticosteroids increased the adjusted rate ratio for progression of existing diabetes by 34%. In the low-, moderate-, and high-dose groups respective adjusted rate ratio increases of 8%, 30%, and 54% were observed.
"High doses of inhaled corticosteroids commonly used in patients with COPD are associated with an increase in the risk of requiring treatment for diabetes and of having to intensify therapy to include insulin," write the authors.
"Therefore, patients instituting therapy with high doses of inhaled corticosteroids should be assessed for possible hyperglycemia and treatment with high doses of inhaled corticosteroids limited to situations where the benefit is clear," they conclude.
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By Helen Albert