Quantification of the risk of corticosteroid-induced diabetes mellitus among the elderly

Blackburn, David; Hux, Janet E.; Mamdani, Muhammad

doi:10.1046/j.1525-1497.2002.10649.x

Cited by 172 publications

(115 citation statements)

References 12 publications

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“…We did not have data on the dosage or frequency of steroid use, so we were unable to control for it. The risk of developing corticosteroid-induced diabetes has only been seen with the use of systemic steroids (46,47), whereas there is no evidence for an association with the use of inhaled corticosteroids (47). In our cohort, at two different time points, there was no significant difference in the use of oral steroids between participants with asthma and COPD.…”

Section: Results -contrasting

confidence: 54%

Chronic Obstructive Pulmonary Disease, Asthma, and Risk of Type 2 Diabetes in Women

et al. 2004

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OBJECTIVE -Inflammation plays a key role in chronic obstructive pulmonary disease (COPD) and asthma. Increasing evidence points toward a role of inflammation in the pathogenesis of type 2 diabetes. We wanted to determine the relation of COPD and asthma with the development of type 2 diabetes. RESEARCH DESIGN AND METHODS -TheNurses' Health Study is a prospective cohort study. From 1988From -1996,614 female nurses were asked biennially about a physician diagnosis of emphysema, chronic bronchitis, asthma, and diabetes.RESULTS -During 8 years of follow-up, we documented a total of 2,959 new cases of type 2 diabetes. The risk of type 2 diabetes was significantly higher for patients with COPD than those without (multivariate relative risk 1.8, 95% CI 1.1-2.8). By contrast, the risk of type 2 diabetes among asthmatic patients was not increased (1.0, 0.8 -1.2). The asthma results remained nonsignificant even when we evaluated diabetes risk by duration of asthma exposure.CONCLUSIONS -Our findings suggest that COPD may be a risk factor for developing type 2 diabetes. Differences in the inflammation and cytokine profile between COPD and asthma might explain why COPD, but not asthma, is associated with increased risk of type 2 diabetes. Diabetes Care 27:2478 -2484, 2004C hronic inflammation has emerged as a new risk factor for the development of type 2 diabetes (1-3). Increasing evidence now points toward a role of proinflammatory cytokines such as C-reactive protein (CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-␣ in the pathogenesis of insulin resistance and type 2 diabetes (1-4). Due to the upregulation of proinflammatory cytokines in both asthma and chronic obstructive pulmonary disease (COPD) (5,6), one might hypothesize that these chronic inflammatory diseases would increase risk for type 2 diabetes.However, the pattern of inflammation for asthma and COPD differs (7). The cellular infiltrate in asthma contains prominent numbers of eosinophils and type 2 helper (Th2) CD4 T-cells and associated cytokines (IL-4, -5, and -13) (5). By contrast, the cellular infiltrate in COPD is dominated by neutrophils, macrophages, and an increased numbers of lymphocytes thought to be type 1 helper (Th1) or CD8 T-cells (8), and the neutrophilassociated cytokines (TNF-␣, IL-6, and IL-8) predominate (9). A recent report (10) from the Third National Health and Nutrition Examination Survey demonstrated that increasing severity of COPD was associated with increasing levels of CRP. Moreover, systemic inflammation in COPD is associated with increased muscle wasting and a continuous hypoxemic state due to destruction of lung tissue (11). Because of these inflammatory differences, the relationship of COPD or asthma with the development of another condition with an inflammatory component, such as type 2 diabetes, may vary. We therefore evaluated the association between a history of physiciandiagnosed COPD or asthma and incidence of type 2 diabetes among almost 100,000 participants in the Nurses' Health Study. We focused on potential ...

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Section: Results -contrasting

confidence: 54%

Chronic Obstructive Pulmonary Disease, Asthma, and Risk of Type 2 Diabetes in Women

et al. 2004

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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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“…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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Quantification of the risk of corticosteroid-induced diabetes mellitus among the elderly

Cited by 172 publications

References 12 publications

Chronic Obstructive Pulmonary Disease, Asthma, and Risk of Type 2 Diabetes in Women

Chronic Obstructive Pulmonary Disease, Asthma, and Risk of Type 2 Diabetes in Women

Inhaled corticosteroids in COPD: the clinical evidence

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

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