Risk of new onset diabetes mellitus in patients with asthma or COPD taking inhaled corticosteroids

O'Byrne, Paul M.; Rennard, Stephen I.; Gerstein, Hertzel C.; Radner, Finn; Peterson, Stefan; Lindberg, Bengt; Carlsson, Linda; Sin, Don D.

doi:10.1016/j.rmed.2012.07.011

Cited by 89 publications

(61 citation statements)

References 10 publications

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“…The incidence of diabetes in patients with COPD is insufficiently common for an increase in risk to be picked up in the large COPD trials. A recent meta-analysis of trials of budesonide in both asthma and COPD did not find an excess of diabetes reported as an adverse outcome [84]. However, an increase in blood glucose has been described among diabetic patients receiving ICS [85].…”

Section: Safety Of Ics and Laba/ics In Copdmentioning

confidence: 97%

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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Section: Safety Of Ics and Laba/ics In Copdmentioning

confidence: 97%

Inhaled corticosteroids in COPD: the clinical evidence

2014

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“…For example, a study 69 performed in a large Veterans Affairs population suggested that, although ICSs were not associated with hyperglycemia in individuals without DM, among people with DM, ICS use was correlated with glucose levels in a dose-dependent manner. A number of small studies of adults 73,74 have similarly linked hyperglycemia among diabetic individuals, but not individuals without DM, to ICS use.…”

Section: Primary Recommendationsmentioning

confidence: 99%

Endocrine Effects of Inhaled Corticosteroids in Children

et al. 2016

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“…Moreover, in patients already treated for diabetes with oral hypoglycemic agents, the risk of progression to insulin also increased by 34 % with the use of ICS, with the higher doses associated with a 54 % increase [46]. A recent meta-analysis [48] evaluated double-blind, placebo-controlled trials involving budesonide or budesonide/formoterol in asthma and in COPD, and did not identify increased risk of new onset diabetes or hyperglycemia. However, the authors found that the risk for diabetes/hyperglycemia in budesonide-treated patients increased with increasing age.…”

Section: Diabetesmentioning

confidence: 99%

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

et al. 2015

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Inhaled corticosteroids (ICSs) are widely used in the treatment of patients with chronic obstructive pulmonary diseases. However, high-dose regimens and longterm use of ICSs have the potential to cause a variety of local and systemic side effects such as candidiasis, cataracts, glaucoma, and osteoporosis. The use of ICSs can also be associated with the risk of bone fractures, diabetes mellitus and pneumonia. These ICS-related side effects are of particular importance in elderly patients due to the presence of comorbidities and age-related behavioral, cognitive, and psychological problems, which can all interact with inhaled treatment. We reviewed the available literature on the clinically relevant side effects of ICSs in the elderly to provide practical measures to properly monitor and manage the risk of ICSs in the geriatric population. Inspection of the mouth, monitoring of ocular pressure, and use of bone-protective drugs may be necessary in patients on prolonged ICS therapy. Above all, the use of the lowest possible ICS dose and a careful re-assessment of the inhalation procedure should be recommended. Taken together, these observations suggest that physicians should use ICSs appropriately for those patients in whom the benefit will outweigh the risk, especially chronic obstructive pulmonary disease (COPD) patients with previous frequent exacerbations. Given the paucity of information on the topic and the need to extrapolate the results from studies with broader age ranges, we strongly encourage the design of specifically tailored clinical studies in the elderly. Key PointsAsthma and chronic obstructive pulmonary disease (COPD) are inflammatory disorders of the airways. The pharmacological management of these chronic diseases is based on persistent and long-term use of inhaled corticosteroids (ICSs).Asthma and COPD are among the most common chronic diseases in clinical settings, and physicians are expected to diagnose and manage those diseases in the geriatric population on a daily basis. The management of chronic obstructive respiratory diseases in the geriatric population is complicated by the increased occurrence of comorbidities and associated treatment, and by age-associated physiological and structural changes of the lung.The chronic use of ICSs in the elderly is associated with the increased risk of local and systemic side effects such as candidiasis, cataract, glaucoma, diabetes mellitus, bone fractures, and pneumonia. Physicians should be aware of this in order to select those patients in whom the benefits will outweigh the risks.The online version of the original article can be found under

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Risk of new onset diabetes mellitus in patients with asthma or COPD taking inhaled corticosteroids

Abstract: Treatment with inhaled corticosteroids in patients with asthma or COPD was not associated with increased risk of new onset diabetes mellitus or hyperglycaemia.

Cited by 89 publications

References 10 publications

Inhaled corticosteroids in COPD: the clinical evidence

Inhaled corticosteroids in COPD: the clinical evidence

Endocrine Effects of Inhaled Corticosteroids in Children

Erratum to: Safety Considerations of Inhaled Corticosteroids in the Elderly

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