Inhaled Corticosteroids In COPD And Onset Of Type 2 Diabetes And Osteoporosis: A Matched Cohort Study

Inhaled Corticosteroids In COPD And Onset Of Type 2 Diabetes And Osteoporosis: A Matched Cohort Study

A study by OPRI published in NPJ Primary Care Respiratory Medicine found a link between ICS therapy for patients with COPD and the onset of type 2 diabetes and osteoporosis.1

SINGAPORE – A study by OPRI published in NPJ Primary Care Respiratory Medicine discovered a definitive link and dose response relationship between ICS use and the onset of type 2 diabetes as well as a dose response relationship between ICS use and the progression of diabetes and osteoporosis in COPD patients.

“The unfortunate reality is that although ICS therapy can provide great benefits for COPD patients, the risks involved are poorly characterized,” said first author and founder of OPRI, David Price. “Adverse events such as pneumonia and skin bruising have been noted, however, the evidence regarding the onset of lifelong and burdensome conditions such as type 2 diabetes and osteoporosis is both limited and conflicted.”

This systematic, investigative and experimental study therefore aimed to compare the association of the onset and progression of diabetes as well as the onset of osteoporosis between COPD patients prescribed ICS and those that were only prescribed LABDs so as to guide and improve clinical treatment. This novel study is the first of its kind in Singapore.

Researchers identified a total of 17,970 COPD patients for the diabetes onset cohort, 804 patients for the diabetes progression cohort and 19,898 patients for the osteoporosis cohort using primary care records extracted from the Clinical Practice Research Database (CPRD) and Optimum Patient Care Research Database (OPCRD).

It was discovered that those undergoing ICS therapy had a mean rate of diabetes onset of 1.25 per 100 patient-years as compared to 1.05 for those undergoing LABD therapy. The corresponding mean rates of diabetes progression and osteoporosis onset were 33.3 vs 37.2 and 0.70 vs 0.66 respectively.

Essentially, these results show an increased risk of developing diabetes when undergoing ICS therapy as compared to LABD therapy for COPD. Although the risk of diabetes progression and osteoporosis onset is not significantly increased between groups, a dose-response relationship was observed wherein the risk of both was increased with cumulative ICS exposure.

“This evidence is concerning as corticosteroids tend to be overprescribed in low-risk COPD patients against guideline recommendations,” said Price. “Perhaps this study could push physicians to reconsider the way they prescribe medication to minimize risk to their patients.”

Some scientific uncertainties were observed in this study in terms of limitations which could not be readily resolved by a competent professional. Namely, the databases used collect information primarily for clinical, and not research, purposes. Therefore, relevant information such as hospitalizations and emergency department visits, as well as confounding variables such as socioeconomic status and disease severity could not be accounted for.

Other limitations include a small diabetes progression cohort and the fact that data was only analysed starting from 1.5 years after the prescription of ICS/LABD.

In conclusion, this study acquired new knowledge by showing a definitive link between ICS use and the onset of type 2 diabetes, as well as a dose-response relationship between ICS use and all three outcomes. While there were some limitations, the results of this study may be useful for clinicians to guide their treatment for COPD patients moving forward.

  1. Price DB, Voorham J, Brusselle G, et al. Inhaled corticosteroids in COPD and onset of type 2 diabetes and osteoporosis: matched cohort study. NPJ Prim Care Resp Med 2019 doi: 1038/s41533-019-0150-x