Oral Corticosteroid Bursts Linked to Increased Acute Risks in Type 2 Diabetes: JAMA
Taiwan: Researchers have found in a new study that among patients with type 2 diabetes, short courses of oral corticosteroids were associated with higher risks of gastrointestinal bleeding, pneumonia, and heart failure within 30 days of treatment initiation. The findings highlight the need for careful risk–benefit assessment when prescribing oral corticosteroid bursts in this high-risk population.
The findings, published as a research letter in JAMA Network Open, were reported by Tsung-Chieh Yao, Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan, and colleagues.
Type 2 diabetes affects more than 500 million people worldwide and is associated with substantial morbidity and mortality. Oral corticosteroids can disrupt glucose regulation, and guidelines recommend close monitoring of blood glucose when these medications are started in patients with diabetes. Although prolonged corticosteroid treatment is known to cause serious complications, short-term courses are often considered relatively low risk.
To investigate whether brief corticosteroid exposure was associated with serious adverse events beyond hyperglycemia, researchers conducted a cohort study using Taiwan’s National Health Insurance Research Database from January 2008 through December 2022. The analysis included adults with type 2 diabetes and used a self-controlled case series design, allowing outcomes during corticosteroid exposure periods to be compared with patients’ own baseline periods.
Oral corticosteroid bursts were defined as continuous treatment lasting 14 days or less. The investigators assessed five serious adverse outcomes: gastrointestinal tract bleeding, pneumonia, sepsis, heart failure, and fractures. Syncope was evaluated as a negative control outcome. Statistical analyses accounted for time-varying factors and multiple comparisons.
A total of 36,048 patients were included, with a mean age of 61.6 years; 52.4% were women and 47.6% were men.
Key findings:
- Within 6 to 30 days after starting an oral corticosteroid burst, the risk of gastrointestinal bleeding increased by 71% (IRR, 1.71).
- Pneumonia risk was approximately doubled (IRR, 2.06).
- Heart failure risk also increased (IRR, 1.87).
- During days 31 to 90, gastrointestinal bleeding remained elevated (IRR, 1.26), while fracture risk increased by 42% (IRR, 1.42).
- No association was identified between corticosteroid bursts and syncope.
- Results remained consistent across multiple sensitivity analyses.
The researchers noted several limitations. Medication adherence could not be confirmed, while lifestyle factors were unavailable in the database, leaving the possibility of residual confounding. Outcome misclassification was also possible, although previous validation studies support the reliability of the outcome definitions. In addition, the findings may not be directly applicable to populations with different ethnic backgrounds.
Overall, the study found that short oral corticosteroid courses were associated with increased risks of gastrointestinal bleeding, pneumonia, and heart failure soon after treatment initiation in adults with type 2 diabetes. The findings underscore the importance of considering potential harms and alternative treatments when prescribing corticosteroid bursts to this population.
Reference:
Yao T, Hsu C, Sheu WH, et al. Oral Corticosteroid Bursts and Risk of Serious Adverse Events in Adults With Type 2 Diabetes. JAMA Netw Open. 2026;9(9):e2635604. doi:10.1001/jamanetworkopen.2026.35604
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