Long-term higher doses of inhaled corticosteroids may increase diabetes risk in COPD patients

A recent systematic review and meta-analysis examining the impact of inhaled corticosteroids (ICS) on diabetes risk among Chronic Obstructive Pulmonary Disease (COPD) patients found compelling evidence indicating a potential association between long-term ICS use, particularly at higher doses, and an increased risk of developing diabetes. This study was published in Tzu Chi Medical Journal by Kholis F N and colleagues.

The study, conducted through a systematic search across PubMed, EBSCOhost, and ProQuest databases from 2013 to 2023, included a total of 14 studies comprising 10 randomized controlled trials (RCTs) and 4 observational studies. The meta-analysis, following PRISMA 2020 guidelines, aimed to comprehensively assess the relationship between ICS use, diabetes risk, and blood glucose levels in COPD patients.

The analysis of RCTs did not yield a statistically significant increase in blood glucose levels after a 52-week follow-up period (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.88-1.30). However, the observational studies suggested a tendency toward an elevated risk of diabetes (OR 1.40, 95% CI 0.96-2.03). Notably, a subgroup meta-analysis focusing on high-dose ICS (>900 μg/day) revealed a significant increase in the risk of diabetes (OR 1.20, 95% CI 1.09-1.32).

Researchers emphasized that while short-term use of ICS did not display a significant impact on blood glucose levels, prolonged and high-dose utilization showed a concerning association with an elevated risk of developing diabetes among COPD patients.

The findings underscore the need for careful consideration when prescribing long-term ICS treatment to COPD patients, particularly at higher doses, given the potential risk of adverse metabolic effects. These results prompt a reevaluation of treatment strategies, urging healthcare professionals to balance the benefits of ICS therapy against the potential risk of exacerbating diabetes in this patient population.

Reference:

Fathur Nur Kholisa, Kevin Gracia Pratamab*, Jessica Novia Hadiyanto. Association between inhaled corticosteroid use and risk of hyperglycemia in patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis. Tzu Chi Medical Journal 2023; 35(4):355-361