Inhalers Linked to Higher Odds of Diabetes in Asthma,
THURSDAY, Dec. 16 (HealthDay News) -- Asthma and chronic
obstructive pulmonary disease (COPD) patients who are treated with
inhaled corticosteroids may face a significantly higher relative
risk for both the development and progression of diabetes, new
Canadian research suggests.
The warning stems from an analysis of data involving more than
380,000 respiratory patients in Quebec. Inhaler use was associated
with a 34 percent increase in the rate of new diabetes diagnoses
and diabetes progression, the researchers found.
What's more, asthma and COPD patients treated with the highest
dose inhalers appear to face even higher diabetes-related risks: a
64 percent jump in the onset of diabetes and a 54 percent rise in
"High doses of inhaled corticosteroids commonly used in patients with COPD are associated with an increase in the risk of requiring treatment for diabetes and of having to intensify therapy to include insulin," the study team noted in a news release.
Based on their results, researchers from McGill University and
the Lady Davis Research Institute at Jewish General Hospital in
Montreal suggest "patients instituting therapy with high doses of
inhaled corticosteroids should be assessed for possible
hyperglycemia and treatment with high doses of inhaled
corticosteroids limited to situations where the benefit is
Lead investigator Samy Suissa colleagues report their findings
in the most recent issue of the
American Journal of Preventive Medicine.
The research team wrote that despite the fact that inhalers are
recommended for use solely by the most severely ill COPD patients,
they are typically prescribed for a much broader pool that amounts
to about 70 percent of all COPD patients.
The authors found that more than 30,000 of the COPD/asthma
patients in their study developed a new diagnosis diabetes over the
course of five and a half years of treatment. This amounted to a
diabetes onset rate of a little more than 14.2 out of every 1,000
inhaler patients per year.
"These are not insubstantial numbers," Suissa said. "Over a large population,m the absolute numbers of affected people are significant."
In addition, in the same timeframe nearly 2,100 patients already
diagnosed with diabetes before using inhalers experienced a
worsening of their disease that ultimately required upgrading their
diabetes care from pills to insulin shots.
Dr. Stuart Weiss, an endocrinologist with the New York
University Medical Center, suggested that concern should be
directed more at the underlying causes of both diabetes and
asthma/COPD rather than at inhalers themselves.
"I would say that a lot more attention should first be paid to the lifestyle choices, dietary-wise, that lead to the pro-inflammatory conditions that raise the risk for both type 2 diabetes as well as COPD and asthma," said Weiss, who is also a clinical assistant professor at the NYU School of Medicine in New York City. "We don't look at asthma as being a dietary condition, but it absolutely is. Which means that in terms of diabetes and asthma risk, the body is reacting to similar stresses brought about by the over-consumption of overprocessed foods and the lack of consumption of green vegetables."
Noting that the underlying risk for both conditions is similar,
Weiss said he suspected the steroids themselves should not bear all
the blame. "What may be more at the root of this problem," he said,
"is the fact that those who are most at risk for diabetes are the
same people who have the worst asthma and COPD that requires
steroid treatment in the first place."
"Yes, we do know that steroids increase insulin resistance and that people treated with steroids require more aggressive diabetes management," he conceded. "But if we don't generally take an approach that deals with the poor quality of food that people are routinely consuming, the incidence of both these diseases will continue to go up at a dramatic rate."
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