Pneumologie 2017; 71(S 01): S1-S125
DOI: 10.1055/s-0037-1598312
Posterbegehung – Sektion Klinische Pneumologie
COPD I – Andreas Rembert Koczulla/Marburg, Henrik Watz/Großhansdorf
Georg Thieme Verlag KG Stuttgart · New York

Effect of ICS on glycaemic control in patients with COPD and comorbid type 2 diabetes: historical case-matched cohort study

R Russell
1  Nuffield Department of Medicine, University of Oxford
,
D Price
2  Academic Primary Care, University of Aberdeen, United Kingdom; Observational and Pragmatic Research Institute, Changi, Singapore
,
R Mares
3  Research in Real Life Ltd
,
A Burden
4  Cambridge Research Support
,
D Skinner
5  Optimum Patient Care
,
H Mikkelsen
4  Cambridge Research Support
,
NH Chavannes
6  Department of Public Health and Primary Care, Leiden University Medical Center
,
JWH Kocks
7  Department of General Practice and Griac Research Institute, University Medical Center Groningen
,
JW Stephens
8  Diabetes Research Group, Institute of Life Sciences, Swansea University
,
J Haughney
9  Academic Primary Care, University of Aberdeen
› Author Affiliations
Further Information

Publication History

Publication Date:
23 February 2017 (online)

 

Introduction:

Type 2 diabetes mellitus (T2DM) is a common comorbidity of COPD. ICS treatment may be associated with reduced glycaemic control and increased risk of diabetic complications.

Aim:

To assess the effects of ICS on diabetes control in patients (pts) with COPD and T2DM.

Methods:

2 UK primary care databases of > 11 million pts were searched (2008 – 2012) for pts with COPD and T2DM receiving ICS/non-ICS therapy. Pts were matched 1:1 for age, sex, body mass index, baseline HbA1c, COPD severity and medications. Primary endpoint: HbA1c (change from baseline) during the 12 – 18-month observation period. A subgroup analysis was conducted in pts with mild to moderate COPD (GOLD A+B), for whom ICS are not recommended by GOLD.

Results:

682 pts matched per arm; mean age 70 years; 73% men; 95% current or ex-smokers. Pts receiving ICS had a significantly greater increase in HbA1c vs. non-ICS pts, notably for GOLD A+B groups. Higher cumulative ICS doses were associated with loss of glycaemic control (Table).

Conclusions:

ICS therapy for COPD is associated with reduced glycaemic control. Risk/benefit analyses of ICS in COPD should be considered, especially in pts with T2DM.

Funding:

Boehringer Ingelheim

Tab. 1

Comparison

Adjusted difference in change in HbA1c from baseline to outcome period, % (95% confidence interval)

ICS vs. non-ICS

0.16 (0.05, 0.27)

GOLD A+B

0.25 (0.10, 0.40)

Adjusted odds ratio of increased HbA1c and/or receiving additional antidiabetic medication (95% confidence interval)

High (> 250 mg) vs. low (≤125 mg) cumulative dose of ICS

1.49 (1.02, 1.98)

Cumulative dose of ICS measured in fluticasone propionate equivalents from the first ICS prescription at the index date to the outcome period HbA1c: median 412 days. 250 mg comparable to 1000 µg/day over 250 days; 125 mg comparable to 500 µg/day over 250 days

Content already presented at ERS congress 2016