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Inhaled corticosteroids linked to increases in diabetes incidence
Suissa S. Am J Med. 2010;doi:10.1016/j.amjmed.2010.06.019.
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Treatment with inhaled corticosteroids in people with asthma and chronic obstructive pulmonary disease raised the risk for diabetes onset for current users by 34%, but recent data indicate that patients receiving higher doses were hit hardest.
“[Inhaled corticosteroids] are very effective in treating asthma, so the benefits clearly outweigh the risk for asthmatics,” Samy Suissa, PhD, study researcher and director of the Centre for Clinical Epidemiology at the Lady Davis Research Institute in Montreal, said in a press release. “However, their effectiveness is questionable in [chronic obstructive pulmonary disease], where they are also used in higher doses. This is a very different risk/benefit situation.”
Canadian researchers also noted that prevalence and incidence of type 2 diabetes are higher in patients with chronic obstructive pulmonary disease. “The co-existence of these two chronic conditions among the elderly becomes important if corticosteroid medications used in the treatment of [chronic obstructive pulmonary disease] also are associated with deterioration in glycemic control,” they wrote.
To investigate the connection between inhaled corticosteroids and potential onset and progression of diabetes, the researchers conducted a population-based cohort study using information from the agency administering Quebec’s universal health insurance program — Régie de l’assurance maladie du Québec.
The study cohort was composed of 388,584 patients, with 30,167 experiencing diabetes onset during a mean of 5.5 years of follow-up. Calculations put annual incidence rate at 14.2 per 1,000 patients.
Results also revealed that 2,099 patients progressed from oral hypoglycemic treatment to insulin, translating to an annual incidence rate of 14.2 per 1,000 patients for diabetes progression.
Data also linked inhaled corticosteroids with a 34% boost in the incidence of diabetes onset (RR=1.34; 95% CI, 1.29-1.39), although the greatest increase was seen among patients receiving the highest doses or the equivalent of at least 1,000 mcg of fluticasone daily.
Incidence of diabetes progression also rose with the current use of inhaled corticosteroids, with results indicating an RR of 1.64 (95% CI, 1.52-1.76). Again, the highest doses were associated with the greatest increase in incidence of diabetes progression (RR=1.54; 95% CI, 1.18-2.02).
“These are not insubstantial numbers,” Suissa said. “Over a large population, the absolute numbers of affected people are significant. We recommend that physicians reserve the use of inhaled steroids for the patients who truly benefit from these medications, namely asthmatics, and curb their use in [chronic pulmonary disorder] to the few patients for whom they are indicated. In all cases, patients using high doses should be assessed for possible hyperglycemia and the lowest effective dose targeted.”
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