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The Effect of an Inhaled Corticosteroid on Glucose Control in Type 2 Diabetes

Department of Respiratory Medicine Connolly Hospital, Dublin, Ireland

Sandra R. Wilson, PhD

Palo Alto Medical Foundation Research Institute Palo Alto, California, USA and Division of Pulmonary and Critical Care Medicine, Stanford University Palo Alto, California, USA

James W. Chu, MD

Division of Endocrinology and Metabolism, Stanford University School of Medicine, Palo Alto, California, USA

James Canfield, BS

Pulmonary Section, Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA

Ware G. Kuschner, MD

Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, California, USA and Pulmonary Section, Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA

Reprint Requests: Ware G. Kuschner, MD, U.S. Department of Veterans Affairs, Palo Alto Health Care System, 3801 Miranda Avenue, Mail Code: 111P, Palo Alto, CA, 94304, final, Tel: 650-493-5000, ext. 63544, Fax: 650-852-3276, Email:kuschner{at}stanford.edu

Abstract

Objective: To determine the effect of inhaled corticosteroid (ICS) therapy on glucose control in adults with type 2 diabetes mellitus and coexisting asthma or chronic obstructive pulmonary disease (COPD).

Design: A prospective randomized, double-blind, double dummy, placebo-controlled, crossover investigation of inhaled steroids and oral leukotriene blockers.

Setting: A United States Department of Veterans Affairs Health Care System outpatient setting.

Participants: Adults with type 2 diabetes and asthma or COPD.

Methods: Subjects (n=12) were randomized to receive either inhaled fluticasone propionate (440 µg twice daily) and oral placebo, or inhaled placebo and oral montelukast (10 mg/day). After 6 weeks, subjects were switched to the opposite therapy for 6 weeks. The primary outcome measure was the change in the percentage of glycosylated hemoglobin (% GHb) at 6 weeks relative to the baseline value.

Results: Ten patients completed the study. The difference between the mean within-subject changes in %GHb associated with 6 week periods of fluticasone and the mean changes associated with montelukast therapy was small but statistically significant (mean difference = 0.25; P < 0.025). Neither fluticasone nor oral montelukast therapy for 6 weeks led to a significantly different mean %GHb compared with the relevant baseline (mean differences = 0.11 and –0.14, respectively).

Conclusion: The absence of a clinically significant within-subject difference in the changes in %GHb associated with fluticasone versus oral montelukast therapy, or between either therapy and baseline does not warrant recommending changes in asthma or diabetes therapy in patients with these co-morbid conditions. However, we suggest that clinicians carefully monitor blood glucose control when diabetic patients initiate ICS, especially with higher dosages of ICS.

Key Words: Asthma • COPD • diabetes mellitus • inhaled steroid

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				F. Laghi, N. Adiguzel, and M. J. Tobin Endocrinological derangements in COPD Eur. Respir. J., October 1, 2009; 34(4): 975 - 996. [Abstract] [Full Text] [PDF]