Deteriorating diabetic control associated with high-dose inhaled budesonide

Faul, JL; Cormican, LJ; Tormey, V; Tormey, William; Cm, Burke

doi:10.1183/09031936.99.141

Cited by 16 publications

(1 citation statement)

References 2 publications

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“…There have been few case reports acknowledging the worsening of glycaemic control in patients commenced on high dose ICS including worsening of HbA1c [ 72 ]. However, a small prospective double-blind randomized controlled trial (n=12) found no difference in HbA1c values in patients with known asthma or COPD and diabetes on inhaled steroids at six weeks [ 73 ].…”

Section: Inhaled Corticosteroids and Diabetes Risk Or Progressionmentioning

confidence: 99%

Systemic Effects of Inhaled Corticosteroids: An Overview

Pandya¹,

Puttanna²,

Balagopal³

2014

TORMJ

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Inhaled corticosteroids (ICS) are common medications, used in respiratory medicine for controlling conditions such as asthma and other obstructive airway diseases. The systemic effects of oral corticosteroids are well known and established; inhaled steroids have been known to cause relatively minor and localized adverse effects such as oral candidiasis. However, less attention has been paid to their systemic effects. Although currently there is a paucity of prospective studies demonstrating the systemic effects of inhaled corticosteroids, there are numerous retrospective studies adding evidence to this link. Inhaled corticosteroids can affect the hypothalamo-pituitary-adrenal axis, bone density and growth, eyes, skin and immunity including an increased risk of pneumonia. Clinicians are recommended to aim for the lowest possible dose to avoid these systemic side effects. Fluticasone is more likely to cause systemic effects compared to budesonide. Newer ICS molecules such as ciclesonide may be more beneficial in reducing such systemic complications on prolonged use. This paper provides an updated overview of the common systemic effects encountered with ICS treatment.

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Section: Inhaled Corticosteroids and Diabetes Risk Or Progressionmentioning

confidence: 99%

Systemic Effects of Inhaled Corticosteroids: An Overview

Pandya¹,

Puttanna²,

Balagopal³

2014

TORMJ

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Effects of inhaled budesonide on insulin sensitivity in nondiabetic patients with asthma and chronic obstructive pulmonary disease

et al. 2007

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In the study reported here, investigators explored the following: (1) the effects of inhaled corticosteroid (ICS) therapy on insulin sensitivity (IS) (the Homeostatic Model Assessment-Insulin Resistance [HOMA-IR] Index, which has never been used before in nondiabetic patients with asthma and chronic obstructive pulmonary disease [COPD], was used in this investigation); and (2) differences and similarities between asthma and COPD groups. A total of 12 patients with asthma and 6 with COPD who were not previously treated with oral corticosteroids or ICSs were treated with budesonide, 400 microg twice daily for 8 wk, via dry powder inhaler through the Aerolizer. Pretreatment and posttreatment values were recorded for forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC), FEV(1)/FVC, C-reactive protein (CRP), blood glucose, serum insulin levels, area under the curve (AUC) for glucose and insulin in an oral glucose tolerance test (OGTT), and HOMA-IR Index. The trapezoid technique, the formula for HOMA-IR, and Wilkinson, Mann-Whitney U, and t tests were used. In the group of patients with asthma, posttreatment values for the HOMA-IR Index, glucose, and insulin at all time points during OGTT and AUC for glucose and AUC for insulin were not statistically different compared with pretreatment values. In patients with COPD who had been given ICS therapy, however, the second hour glucose level during OGTT increased significantly compared with pretreatment values (P=.46). Pretreatment and posttreatment second hour insulin values and posttreatment AUC for glucose were significantly higher in the COPD group than in the asthma group (P=.047, P=.044, and P=.031, respectively). A moderate positive correlation was noted between the percentage of difference in FEV1 and the change in HOMA-IR (pretreatment mean value of HOMA-IR+/-standard deviation [SD], 2.7+/-2.6) in asthmatic patients as the result of therapy (r=0.50, P=.138). Investigators concluded the following: (1) Differences in pathogenesis between asthma and COPD seem to offer the most plausible explanation for differences in carbohydrate metabolism achieved through ICS therapy; (2) the effect of an ICS on IS is associated not only with dose, treatment period, age, and body mass index (BMI) but also with the severity of initial mucosal inflammation; and (3) as a result of improvements in respiratory function noted after treatment had been given, IS was increased in asthmatic patients.

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Corticosteroids—glucocorticoids, inhaled

2006

Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions

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Deteriorating diabetic control associated with high-dose inhaled budesonide

Cited by 16 publications

References 2 publications

Systemic Effects of Inhaled Corticosteroids: An Overview

Systemic Effects of Inhaled Corticosteroids: An Overview

Effects of inhaled budesonide on insulin sensitivity in nondiabetic patients with asthma and chronic obstructive pulmonary disease

Corticosteroids—glucocorticoids, inhaled

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