Abstract
BackgroundThe effect of inhaled corticosteroids (ICS) on risk of hyperglycemia in patients with chronic obstructive pulmonary disease (COPD) remains ambiguous. The aim of this study is to evaluate the association between ICS use and the incidence of hyperglycemia related adverse effects in COPD patients.MethodsMedline/PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov were searched from inception to 25 May 2020. Randomized controlled trials (RCTs) of ICS versus control (non-ICS) treatment for COPD patients reporting on risk of hyperglycemia were included. The Mantel–Haenszel method with fixed-effects modeling was used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs).ResultsSeventeen RCTs with 43,430 subjects were included in the meta-analysis. Pooled results suggested that there was no statistically significant difference in the risk of hyperglycemia between the ICS group and the control group (RR 1.02, 95% CI 0.90–1.16, P = 0.76). In addition, no significant difference was noted in the effect on glucose level (RR 1.20, 95% CI 0.79–1.82, P = 0.40), risk of diabetes progression (RR 0.84, 95% CI 0.20–3.51, P = 0.81) and new onset diabetes mellitus (RR 1.0, 95% CI 0.88–1.15, P = 0.95) between the ICS group and the control group. These findings also were consistent across all subgroup analyses.ConclusionsUse of ICS does not have an effect on the blood glucose and is not associated with the risk of new onset diabetes mellitus and diabetes progression in patients with COPD. Further RCTs exploring the association between ICS use and risk of hyperglycemia in COPD patients are still needed to verify our results of this analysis.
Highlights
The effect of inhaled corticosteroids (ICS) on risk of hyperglycemia in patients with chronic obstructive pulmonary disease (COPD) remains ambiguous
There was no significant difference between the ICS group and the control group in the risk of new onset diabetes mellitus (RR 1.0, 95% Confidence interval (CI) 0.88–1.15, P = 0.95)
The influence of corticosteroid therapy in asthma on diabetes control was assessed, and this study revealed that ICS administered in low or mild doses do not affect fasting glycemia [35]
Summary
The effect of inhaled corticosteroids (ICS) on risk of hyperglycemia in patients with chronic obstructive pulmonary disease (COPD) remains ambiguous. The aim of this study is to evaluate the association between ICS use and the incidence of hyperglycemia related adverse effects in COPD patients. The treatment containing ICS has a role in dual and triple therapy for COPD to reduce the risk of exacerbations and improve symptoms, ICS-related safety issues remain a serious concern. Some observational studies revealed increased risk of onset and progression of diabetes, especially when higher ICS doses were utilized [10, 11]. There is currently no consensus on the association between ICS therapy and risk of hyperglycemia and diabetes
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