Inhaled steroids associated with 34% increase in the rate of diabetes?

Systemic corticosteroids are known to increase diabetes risk, but the effects of high-dose inhaled corticosteroids are unknown.

This study from Canada included a cohort of almost 400,000 patients treated for respiratory disease during 1990-2005. They were identified using the Quebec health insurance databases and followed through 2007 or until diabetes onset.

Current use of inhaled corticosteroids was associated with a 34% increase in the rate of diabetes (rate ratio [RR] 1.34) and in the rate of diabetes progression (RR 1.34).

The risk increases were greatest with the highest inhaled corticosteroid doses, equivalent to fluticasone 1,000 mcg per day or more (RR 1.64)

The study authors concluded that inhaled corticosteroid use is associated with modest increases in the risks of diabetes onset and diabetes progression. The risks are more pronounced at the higher doses, currently prescribed in the treatment of chronic obstructive pulmonary disease (COPD).

The risk is small and patients must not stop taking their asthma medications without discussing it with their doctor.

Anti-diabetes medications Avandia and Actos are peroxisome proliferator-activated receptor-γ (PPARγ) agonists that have anti-inflammatory effects and are currently in clinical trials for treatment of asthma.

References:

Inhaled Corticosteroids and the Risks of Diabetes Onset and Progression. The American Journal of Medicine, Volume 123, Issue 11, Pages 1001-1006, November 2010.

Comments from Twitter:

@sdietrich17 (Sharon Dietrich): Is there no end of "good" news about drugs we trusted and worked well for their purpose?? Discouraging!!

@DrVes: look at it from another angle - we know a lot more about the drugs that have been in use for 30+ years now... including both safety profile and side effects. Knowing the side effects that occur even in a small group of patients would make the physicians more vigiliant. Also, it would help to target the medication to a particular group of patients that is likely to benefit most from it.

@sdietrich17 (Sharon Dietrich): Understood, of course. But we were told for years that absorption of inhaled steroids was not enough to cause diabetes --and they work!!