Comorbid diabetes and copd: impact of corticosteroid use on diabetes complications

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dc.contributor.authorCaughey, G.E.
dc.contributor.authorPreiss, A.K.
dc.contributor.authorVitry, A.I.
dc.contributor.authorGilbert, A.L.
dc.contributor.authorRoughead, E.E.
dc.date.issued2013
dc.description.abstractOBJECTIVE: To identify if there is a dose-dependent risk of diabetes complications in patients treated with corticosteroids who have both diabetes and chronic obstructive pulmonary disorder (COPD). RESEARCH DESIGN AND METHODS: A retrospective study of administrative claims data from the Australian Government Department of Veterans' Affairs, from 1 July 2001 to 30 June 2008, of diabetes patients newly initiated on metformin or sulfonylurea. COPD was identified by dispensings of tiotropium or ipratropium in the 6 months preceding study entry. Total corticosteroid use (inhaled and systemic) in the 12 months after study entry was determined. The outcome was time to hospitalization for a diabetes-related complication. Competing risks and Cox proportional hazard regression analyses were conducted with adjustment for a number of covariates. RESULTS: A total of 18,226 subjects with diabetes were identified, of which 5.9% had COPD. Of those with COPD, 67.2% were dispensed corticosteroids in the 12 months from study entry. Stratification by dose of corticosteroids demonstrated a 94% increased likelihood of hospitalization for a diabetes complication for those who received a total defined daily dose (DDD) of corticosteroids≥0.83/day (subhazard ratio 1.94 [95% CI 1.14-3.28], P=0.014), by comparison with those who did not receive a corticosteroid. Lower doses of corticosteroid (<0.83 DDD/day) were not associated with an increased risk of diabetes-related hospitalization. CONCLUSIONS: In patients with diabetes and COPD, an increased risk of diabetes-related hospitalizations was only evident with use of high doses of corticosteroids. This highlights the need for constant revision of corticosteroid dose in those with diabetes and COPD, to ensure that the minimally effective dose is used, together with review of appropriate response to therapy.
dc.description.statementofresponsibilityGillian E. Caughey, Adrian K. Preiss, Agnes I. Vitry, Andrew L. Gilbert, Elizabeth E. Roughead
dc.identifier.citationDiabetes Care, 2013; 36(10):3009-3014
dc.identifier.doi10.2337/dc12-2197
dc.identifier.issn0149-5992
dc.identifier.issn1935-5548
dc.identifier.orcidCaughey, G.E. [0000-0003-1192-4121]
dc.identifier.urihttp://hdl.handle.net/2440/113254
dc.language.isoen
dc.publisherAmerican Diabetes Association
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/401832
dc.rights© 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/ licenses/by-nc-nd/3.0/ for details.
dc.source.urihttps://doi.org/10.2337/dc12-2197
dc.subjectPulmonary Disease, Chronic Obstructive
dc.titleComorbid diabetes and copd: impact of corticosteroid use on diabetes complications
dc.typeJournal article
pubs.publication-statusPublished

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