Subscribe to RSS
DOI: 10.1055/s-0037-1598312
Effect of ICS on glycaemic control in patients with COPD and comorbid type 2 diabetes: historical case-matched cohort study
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
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