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.
- Received September 11, 2008.
- Revision received January 15, 2009.
- Accepted January 21, 2009.
