The Effect of an Inhaled Corticosteroid on Glucose Control in Type 2 Diabetes

Abstract

Objective:To determine the effect of inhaled corticosteroid (ICS) therapy on glucose control in adults with type 2 diabetes mellitus and coexisting asthma or chronic obstructive pulmonary disease (COPD).Design: A prospective randomized, double-blind, double-dummy placebo-controlled, crossover investigation of inhaled steroids and oral leukotriene blockers. Setting:A United States Department of Veterans Affairs Health Care System outpatient setting.Participants: Adults with type 2 diabetes and asthma or COPD.Methods: Subjects (n=12) were randomized to receive either inhaled fluticasone propionate (440 µg twice daily) and oral placebo, or inhaled placebo and oral montelukast (10 mg/day). After 6 weeks, subjects were switched to the opposite therapy for 6 weeks. The primary outcome measure was the change in the percentage of glycosylated hemoglobin (%HbA1c) at 6 weeks relative to the baseline value.Results: Ten patients completed the study. The difference between the mean within-subject changes in %HbA1c associated with 6-week periods of fluticasone and the mean changes associated with montelukast therapy was small but statistically significant (mean difference=0.25; P<0.025). Neither fluticasone nor oral montelukast therapy for 6 weeks led to a significantly different mean % HbA1c compared with the relevant baseline (mean differences=0.11 and -0.14, respectively). Conclusion:The absence of a clinically significant within-subject difference in the changes in %HbA1c associated with fluticasone versus oral montelukast therapy, or between either therapy or baseline does not warrant recommending changes in therapy for asthma or diabetes in patients with these co-morbid conditions. However, we suggest that clinicians carefully monitor blood glucose control when diabetic patients initiate ICS, especially with higher dosages.

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

“…73.91% patients were on systemic corticosteroid therapy which is higher in comparison to current trends in developed countries as shown in previous studies by Miravitlles M et al and Jackevicius C at al. 10,11 In this study only 26.09% patients were taking inhaled corticosteroids and which is quite lower than studies conducted in developed [12][13][14][15] In current study 15.22% patients had diabetes mellitus which is comparable to studies conducted by Slatore CG et al, Faul JL et al, Suissa S et al and Gartlehner G et al [27][28][29][30] Impaired glucose tolerance was found in 30.43% patients. Smyllie HC et al and Slatore CG et al concluded that glucose control is more difficult with steroid based therapy in COPD.…”

“…[25][26][27] One study shows 15% of COPD patient requires additional treatment for hyperglycemia as compared to 4% of control group. [28][29][30] In addition to this some case reports describe loss of glucose control in patient receiving ICS based therapy. 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.…”

Endocrine Effects of Inhaled Corticosteroids in Children

“…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.…”

Influence of chronic comorbidity and medication on the efficacy of treatment in patients with diabetes in general practice

“…Faul et al 32 did not find a significant impact of corticosteroid use on changes in HbA1c levels, despite suggesting careful monitoring of blood glucose levels for patients initiating use of corticosteroids. It seems sensible that, although starting corticosteroids or a change in dosage can lead to short periods of increased glycaemia, chronic corticosteroid use is easily controlled by adapting the treatment prescription.…”