COPD: inhaled corticosteroids are linked to increased T2D risk

  • Ställberg B & al.
  • NPJ Prim Care Respir Med
  • 20.10.2020

  • von Miriam Tucker
  • Clinical Essentials
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Takeaway

  • In patients with COPD, inhaled corticosteroid (ICS) treatment is associated with an increased risk of developing type 2 diabetes (T2D).

Why this matters

  • Data on the association have conflicted.
  • Real-world data suggest that ICS combined with long-acting beta-2 agonists is overused in patients with COPD.

Study design

  • Electronic medical record data analyzed for 7078 patients with COPD age ≥40 years in 52 Swedish primary care centers, 2000-2014.
  • High- and low-dose ICS defined as ≥640 and
  • Funding: Uppsala University.

Key results

  • T2D was reported in 5.9% (418) of patients.
  • Compared with no ICS use and with adjustment for BMI, time since COPD, age, and sex, relative risks were (over the study period):
    • Stable low-dose ICS: 1.32 (P=.0201).
    • Stable high-dose ICS: 1.64 (P=.0088).
  • For patients using high-dose ICS, T2D relative risks compared with no ICS were:
    • Increased dosage: 2.00 (P=.0088).
    • Mixed dosage: 1.96 (P=.0234).
  • Adjustment for hypertension and/or heart failure did not significantly affect the results.

Limitations

  • Retrospective design introduces bias and confounding potential.
  • Spirometry data not always available to verify COPD diagnosis or assess impact of disease severity.
  • Single-country study.