Clinical research studyInhaled Corticosteroids and the Risks of Diabetes Onset and Progression
Section snippets
Data Source
We used the computerized databases of the Régie de l'assurance maladie du Québec, the agency responsible for administering the universal health insurance program of the province of Québec, Canada, for all its 7 million residents. The databases contain information on demographics and all medical services rendered, along with the diagnostic code of the service (International Classification of Diseases-9th revision), for all residents of the Province. The prescription drugs database includes
Results
The cohort included 388,584 patients treated with respiratory medications, after excluding 39,068 already treated for diabetes. At cohort entry, the patients were 50.5 (± 27.5) years of age and 46% were men. The mean duration of follow-up was 5.5 years, during which 30,167 patients initiated treatment with antidiabetic medication. Thus, the overall incidence rate of new diabetes onset was 14.2 per 1000 per year. The subcohort of patients treated exclusively with oral hypoglycemic agents
Discussion
Using a large population-based cohort of asthma and COPD patients, we found that the use of inhaled corticosteroids is associated with a significant 34% increase in the risk of incident diabetes, defined as initiation of antidiabetic medications. This risk increased with higher doses of inhaled corticosteroids, with 1000 μg of fluticasone per day or equivalent associated with 64% increase in the risk. Moreover, we found that in patients already treated for diabetes with oral hypoglycemic
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Funding: This research was funded by grants from the Canadian Institutes of Health Research, Boehringer-Ingelheim GmbH, and the Canadian Foundation for Innovation. The sponsors had no role in the design and conduct of the study, including data collection, management, analysis, interpretation, or in the preparation of the manuscript.
Conflict of Interest: Samy Suissa has received speaker fees or has served on advisory boards for AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck, and Pfizer. Pierre Ernst has received speaker fees or has served on advisory boards for AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck Frosst Canada, Novartis, and Nycomed.
Authorship: All authors participated in the preparation of the manuscript.