Inhaled corticosteroids are a standard treatment for asthma; they are also used to treat chronic obstructive pulmonary disease (COPD). But a recent study suggests that these drugs may contribute to the development and progression of diabetes.
This is the first study to link inhaled steroid use to diabetes. Systemic (oral) corticosteroids are already known to increase diabetes risk.
Canadian researchers analyzed data from the health insurance agency of Quebec and found over 388,000 people who were treated for respiratory conditions with inhaled corticosteroids like fluticasone (Flonase®, Advair), budesonide (Pulmicort®, Rhinocort) or beclomethasone (QVAR®, Beclovent).
After a follow-up period averaging 5.5 years, the study revealed that people currently using inhaled corticosteroids had a 34% increase in the incidence of diabetes. The risk was greatest among people who used higher doses of the drugs; doses equivalent to 1000 mcg of fluticasone or more per day, for example, were associated with a 64% risk increase. Among 2099 people with diabetes, there was also a 34% increased risk of progression from taking just oral blood glucose-lowering medications to starting insulin. Higher dosages of inhaled corticosteroid medications were associated with a 54% higher risk of diabetes progression.
COPD & Inhaled Steroids
The widespread use of these drugs in treating COPD has been questioned. "While inhaled corticosteroids are very effective for the treatment of asthma, their effectiveness in treating COPD is controversial," the authors wrote. "The fact that inhaled corticosteroids are now commonly combined in a single device with a long-acting bronchodilator...has resulted in inhaled corticosteroids now being used by over 70% of COPD patients," they wrote. "Moreover, these combined medications contain high doses of inhaled corticosteroids, as high as 1000 mcg of fluticasone per day."
