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Corticosteroid Use May Increase Risk of Diabetes

Use in respiratory disease patients tied to an increased risk of diabetes onset and progression

TUESDAY, Dec. 21 (HealthDay News) -- The use of inhaled corticosteroids among patients with respiratory disease appears to be associated with modest increases in the risk of diabetes onset and progression, according to a study published in the November issue of The American Journal of Medicine.

Samy Suissa, Ph.D., of the Jewish General Hospital and McGill University in Montreal, and colleagues formed a new-user cohort of 388,584 patients treated for respiratory disease between 1990 and 2005, who were identified using the Quebec health insurance databases and followed through 2007 or until diabetes onset. The investigators assessed whether the use and dose of inhaled corticosteroids increased the risk of onset and progression of diabetes.

The researchers found that, among the cohort, 30,167 had diabetes onset during 5.5 years of follow-up, with 2,099 subsequently progressing from oral hypoglycemic treatment to insulin. The investigators found that current use of inhaled corticosteroids was related to a 34 percent increase in the rate of diabetes (rate ratio, 1.34) and in the rate of diabetes progression (rate ratio, 1.34). The risk increases were greatest with the highest inhaled corticosteroid doses, which were equivalent to at least 1,000 µg per day of fluticasone (rate ratio, 1.64).

"In conclusion, high doses of inhaled corticosteroids commonly used in patients with chronic obstructive pulmonary disease are associated with an increase in the risk of requiring treatment for diabetes and of having to intensify therapy to include insulin. Therefore, patients instituting therapy with high doses of inhaled corticosteroids should be assessed for possible hyperglycemia and treatment with high doses of inhaled corticosteroids limited to situations where the benefit is clear," the authors write.

The study was funded in part by Boehringer-Ingelheim; two authors disclosed financial relationships with Boehringer-Ingelheim and other pharmaceutical companies.

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