Use of inhaled corticosteroids and the risk of developing type 2 diabetes in patients with chronic obstructive pulmonary disease

Abstract

Aims The risk of developing type 2 diabetes (T2D) when using inhaled corticosteroids (ICS) is unclear. Previous studies were limited by lack of data regarding important confounders and too short follow‐up periods. The aim of this study was to determine the risk of T2D onset associated with accumulated ICS dose during the previous year in patients with chronic obstructive pulmonary disease (COPD). Materials and methods We conducted a nationwide observational cohort study based on data from patients with COPD between 1 January 2010 and 31 December 2017 extracted from Danish health databases. Patients were followed for seven years, until death or a T2D event. A propensity‐matched Cox model and an adjusted Cox proportional hazards model (stratified on body mass index (BMI)) were used to estimate the hazard ratio (HR) for new‐onset T2D. Results A total of 50,148 patients with COPD were included, 3,566 (7.1%) of whom had a T2D event. 35,368 patients (70.5%) used ICS during the previous year before study entry. The propensity‐matched Cox model (N=33,466) showed an increased risk of T2D which progressed with increasing accumulated ICS dose (low‐ICS: HR 1.076, confidence interval [CI] 1.075‐1.077, ppp2. Conclusions In patients with COPD, ICS use was associated with a moderate dose‐dependent increase in the occurrence of T2D.