The study’s authors say the increase in risk probably doesn’t outweigh the benefits to people taking daily puffs of inhaled corticosteroids to control asthma.
But researchers are worried about the threat of diabetes when these medications are used to ease breathing in patients with chronic obstructive pulmonary disease, or COPD, a condition for which the benefits of inhaled corticosteroids are less clear.
“For asthma, I’m not as concerned because they are so effective. They keep people out of the emergency room. They save lives,” says lead author Samy Suissa, PhD, director for the center of clinical epidemiology at Jewish General Hospital in Montreal.
“In studies, inhaled corticosteroids don’t work for many people with COPD. If there’s no problem with safety, then that is maybe not such a big deal,” Suissa says. "If there’s a problem with safety, then the equation changes.”
Suissa points out that 70% of people with COPD are prescribed inhaled corticosteroids when clinical guidelines suggest that only 15% to 20% really get any benefit from them.
For the study, which is published in the November issue of The American Journal of Medicine, Suissa and his colleagues analyzed the drug records of more than 388,000 patients who were prescribed inhaled corticosteroids in Montreal from 1990 to 2005.
They found that the risk of needing medication to control high blood sugar increased about 34% in patients taking any dose of daily inhaled corticosteroids. In those on the highest doses, the risk increased by 64%. The study also found that inhaled corticosteroids were associated with an increased risk of needing stronger medications to control blood sugar, an indication that diabetes could be worsening in those who already have it.
While a 34% increase in risk may sound alarming, experts point out that the absolute numbers are still very small. For example, the number of people who were diagnosed with diabetes each year rose from 14 out of 1,000 to 20 out of 1,000 in people taking inhaled corticosteroids.
A Small Risk Can Still Mean a Big Problem
“This is a modest increase, but it’s not something to sneeze at because type 2 diabetes is such an expensive problem,” says Elizabeth Kern, MD, director of the diabetes program at National Jewish Health in Denver, a hospital that specializes in the treatment of lung disease.
Kern says the findings of this investigation were much anticipated and somewhat controversial among doctors who treat respiratory problems since previous, smaller studies had failed to find an increased risk of diabetes in patients treated with inhaled corticosteroids.
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