Although the dysglycemic effects of systemic glucocorticoid therapy are well known, the effect of inhaled corticosteroids (ICS) on carbohydrate metabolism is still a subject of debate. The systemic bioavailability of ICS is claimed to be minimal and the side effects negligible. However, some large retrospective cohort studies showed a definite association between ICS use and incident diabetes or worsening glycemic control in pre-existing diabetes. There are no professional-body recommended guidelines on the diagnosis and management of steroid-induced diabetes for the general population. This review aims to evaluate the systemic dysglycemic effect of ICS treatment and to propose a management algorithm.

Conclusions In our cohort of 167, 62% (n=104) of patients had a TL below the recently published recommended guidelines (5 mg/ml) yet were in a clinical remission. Therefore following these guidelines would lead to a significant increase in drug spend which may not translate into improved clinical outcomes; since in this cohort only 24% with sub-therapeutic levels had active disease. Escalating only those with active disease may represent a more acceptable financial solution but too will lead to an increase in drug spend.

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