Inhaled corticosteroids and the risk of diabetes among the elderly

Dendukuri, Nandini; Blais, Lucie; LeLorier, Jacques

doi:10.1046/j.1365-2125.2002.01610.x

Cited by 45 publications

(28 citation statements)

References 25 publications

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“…Although it was reported that elderly patients using oral corticosteroids showed an increased risk for diabetes, inhaled-corticosteroid users did not [82]. Another investigation involving elderly patients treated with inhaled-corticosteroids observed no link with diabetes [83]. In addition, in a retrospective analysis of double-blind, controlled trials, no connection between corticosteroid use and diabetes could be confirmed [84].…”

Section: The Role Of Corticosteroid Therapy In Diabetes Onset and Promentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Diabetes Mellitus: A Systematic Review of the Literature

et al. 2015

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The objective of this systematic review was to discuss our current understanding of the complex relationship between chronic obstructive pulmonary disease (COPD) and type-2 diabetes mellitus (T2DM). We performed a systematic search of the literature related to both COPD and diabetes using PubMed. Relevant data connecting both diseases were compiled and discussed. Recent evidence suggests that diabetes can worsen the progression and prognosis of COPD; this may result from the direct effects of hyperglycemia on lung physiology, inflammation or susceptibility to bacterial infection. Conversely, it has also been suggested that COPD increases the risk of developing T2DM as a consequence of inflammatory processes and/or therapeutic side effects related to the use of high-dose corticosteroids. In conclusion, although there is evidence to support a connection between COPD and diabetes, additional research is needed to better understand these relationships and their possible implications.

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Section: The Role Of Corticosteroid Therapy In Diabetes Onset and Promentioning

confidence: 99%

Chronic Obstructive Pulmonary Disease and Diabetes Mellitus: A Systematic Review of the Literature

et al. 2015

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“…Early database studies did not identify an increased risk of diabetes in users of ICS [82,83]. These studies examined a period of time when the predominant ICS was low-dose beclomethasone.…”

Section: Safety Of Ics and Laba/ics In Copdmentioning

confidence: 99%

Inhaled corticosteroids in COPD: the clinical evidence

2014

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In this article, we focus on the scientific evidence from randomised trials supporting treatment with inhaled corticosteroids (ICS) in chronic obstructive pulmonary disease (COPD), including treatment with combinations of long-acting β-agonist (LABA) bronchodilators and ICS. Our emphasis is on the methodological strengths and limitations that guide the conclusions that may be drawn.The evidence of benefit of ICS and, therefore, of the LABA/ICS combinations in COPD is limited by major methodological problems. From the data reviewed herein, we conclude that there is no survival benefit independent of the effect of long-acting bronchodilation and no effect on FEV1 decline, and that the possible benefit on reducing severe exacerbations is unclear. Our interpretation of the data is that there are substantial adverse effects from the use of ICS in patients with COPD, most notably severe pneumonia resulting in excess deaths.Currently, the most reliable predictor of response to ICS in COPD is the presence of eosinophilic inflammation in the sputum. There is an urgent need for better markers of benefit and risk that can be tested in randomised trials for use in routine specialist practice. Given the overall safety and effectiveness of long-acting bronchodilators in subjects without an asthma component to their COPD, we believe use of such agents without an associated ICS should be favoured. @ERSpublicationsThe benefits of ICS in COPD are limited. Better tools are needed to identify which patients might benefit.

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“…13,31,32 On the other hand, lung health study-2 did not demonstrate an increased risk for a new diagnosis of diabetes mellitus in individual receiving ICS based therapy. 33,34 But it was associated with individual on prolonged oral steroid. 35 So, in order to find out the association between steroid therapy and glycemic state in COPD population, we conducted a study at our rural tertiary centre.…”

Section: Introductionmentioning

confidence: 99%

Assessment of glycemic status of COPD patients on long term corticosteroid therapy

Verma¹,

Nim²,

Kumar³

et al. 2017

Int J Res Med Sci

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Background: Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease characterized by persistent airflow limitation that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Among the pharmacological therapy, inhaled betaagonist and anticholinergics are the mainstay therapy of COPD along with corticosteroid. Steroid therapy is associated with various potential adverse effects like steroid induced deranged glycemic status. So, we sought to examine the association between long term corticosteroid therapy and glycemic status in COPD patients. Methods: A cross sectional study was done to assess the glycemic status in COPD patients on long term corticosteroid therapy in a rural tertiary care centre on patients satisfying inclusion and exclusion criteria. Inclusion criteria includes COPD patients on steroid based therapy (inhaled/systemic or both) for at least 6 months. Known case of type 2 diabetes mellitus, bronchial asthma, interstitial lung disease, coronary artery disease, cardiomyopathies, connective tissue disorders, recipients of organ transplant or immunosuppressive therapy, patients having co morbidities like renal failure, liver failure, heart failure and patients on other drugs known to cause hyperglycemia were excluded. Random blood sugar, HbA1C etc, was done and data was analyzed by SPSS version 22.0. Results: Total 46 patients were included in study. Mean age was 63.22 years with minimum age 47 years and maximum age 80 years. 35 patients (76.09%) were male and 11 patients (23.91%) were female. Sex ratio was 3.18:1. 26 patients (56.52%) were taking both inhaled and systemic corticosteroids, 12 patients (26.09%) were taking only inhaled corticosteroids and 8 patients (17.39%) were taking systemic corticosteroid therapy. 14 patients (30.43%) were found to have impaired glucose tolerance, 7 patients (15.22%) were diagnosed as a case of diabetes mellitus and 25 patients (54.35%) were found to be euglycemic. Conclusions: We conclude that incidence of deranged glycemic status is more common among COPD patients receiving only systemic corticosteroid therapy or both systemic and inhaled corticosteroid therapy. Further, inhaled corticosteroids are better in terms of glycemic control among COPD patients on corticosteroid therapy. Hence, we recommend routine screening of glycemic status in COPD patients on corticosteroid therapy.

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Inhaled corticosteroids and the risk of diabetes among the elderly

Cited by 45 publications

References 25 publications

Chronic Obstructive Pulmonary Disease and Diabetes Mellitus: A Systematic Review of the Literature

Chronic Obstructive Pulmonary Disease and Diabetes Mellitus: A Systematic Review of the Literature

Inhaled corticosteroids in COPD: the clinical evidence

Assessment of glycemic status of COPD patients on long term corticosteroid therapy

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