<p>Do Benefits Outweigh Risks for Corticosteroid Therapy in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in People with Diabetes Mellitus?</p>

Abstract

Chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are chronic health conditions with significant impacts on quality and extent of life. People with COPD and DM appear to have worse outcomes in each of the comorbid conditions. Treatment with corticosteroids in acute exacerbation of COPD (AECOPD) has been shown to reduce treatment failure and exacerbation relapse, and to shorten length of hospital stay, but not to affect the inexorable gradual worsening of lung function. Treatment with corticosteroids can lead to a wide spectrum of side effects and complications, including worsening hyperglycemia and deterioration of diabetes control in those with pre-existing DM. The relationship between COPD and DM is rather complex and accumulating evidence indicates a distinct phenotype of the comorbid state. Several randomized controlled trials on corticosteroid treatment in AECOPD excluded people with DM or did not report on outcomes in this subgroup. As such, the perceived benefits of corticosteroids in AECOPD in people with DM have not been validated. In people with COPD and DM, the detrimental side effects of corticosteroids are guaranteed, while the benefits are not confirmed and only presumed based on extrapolation from the general COPD population. Therefore, the potential for harm when prescribing corticosteroids for AECOPD in people with DM cannot be excluded.

Association between SpO2 and the risk of death in elderly T2DM patients with cerebral infarction: a retrospective cohort study

“…It has been suggested that low oxygen saturation might foster insulin resistance, disrupting glucose homeostasis and intensifying hyperglycemia in T2DM patients. This, in turn, complicated glycemic control, amplifying associated risks ( 22 , 23 ). Moreover, low oxygen saturation could potentiate systemic inflammation and oxidative stress, marked by heightened VEGF and CRP expression, thereby fostering atherosclerosis and vascular dysfunction ( 24 ).…”

A prediction model for hospital mortality in patients with severe community-acquired pneumonia and chronic obstructive pulmonary disease

“…Previous evidence suggested that both COPD and impaired lung function, especially restricted ventilation dysfunction, could increase the risk of diabetes as a consequence of systemic inflammatory processes [ 24 ]. In addition, treatment with corticosteroids in COPD could possibly lead to a variety of side effects, such as worsening hyperglycemia and deterioration of diabetes control [ 25 ]. And reversely, diabetes can worsen the prognosis of COPD due to the direct effects of hyperglycemia on lung physiology, inflammation and susceptibility to bacterial infection [ 26 ].…”

Effect of different corticosteroid regimes for hospitalised patients with exacerbated COPD: pooled analysis of individual participant data from the REDUCE and CORTICO-COP trials

“…These results are similar to those of previous systematic reviews [19] and support the use of shorter systemic corticosteroid treatment regimens. Corticosteroids are well known for their vast array of side effects both in the short term and over an extended period [20], including new/aggravated diabetes [12], hyperglycaemia, and hypertension [14]. Short-term treatment with systemic corticosteroids has also been Table 1 Baseline characteristics of study participants from the primary trials OCS oral corticosteroids, FEV 1 forced expiratory volume in 1 s, SD standard deviation, IQR interquartile range *Data refer to treatment for the index acute COPD exacerbation **Data refer to treatment prior to index acute COPD exacerbation, defined as daily therapy over 2 days or more directly before the day of inclusion associated with an increased risk of bone fractures, venous thromboembolism, and sepsis [9,21], as well as an increased risk of gastrointestinal bleeding or perforation [22].…”

“…The risk of admission to an intensive care unit (ICU) or re-exacerbations after the first month appears to be unaltered [2,3]. Corticosteroids affect the expression of various genes, especially those regulating the innate and the adaptive immune system [4], leading to a variety of beneficial and harmful effects [5][6][7][8] such as increasing the risk of acute or chronic infections [9,10], the onset or aggravation of diabetes mellitus [11,12], and osteoporotic fractures [9]. Therefore, minimising the unnecessary exposure of patients with chronic obstructive pulmonary disease (COPD) exacerbations to systemic corticosteroids is crucial.…”

“…11 The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK. 12…”