COPD: frequent exacerbations, high-dose steroids tied to T2DM

Takeaway

• COPD is associated with a higher incidence of type 2 diabetes mellitus (T2DM).
• The elevated risk is associated with exposure to high-dose inhaled corticosteroids (ICS) and frequent COPD exacerbations.

Why this matters

• Clinicians should aggressively monitor for T2DM among patients with COPD using ICS and having frequent COPD exacerbations.

Study design

• Nested case-control within large retrospective primary care cohort, the Clinical Practice Research Datalink (n=220,971 with COPD).
• 20,488 cases with incident T2DM were compared with 200,483 controls without T2DM matched 1:5 by age, sex, and general practitioner practice.
• Funding: Boehringer Ingelheim Ltd.

Key results

• Among the larger cohort (n=220,971), the incidence of T2DM in patients with COPD was 1.26 (95% CI, 1.24-1.28) per 100 patient years, with the rate being higher among men (1.32 vs 1.18 in women).
• The nested case-control found:
  • Adjusted OR for incident T2DM, 1.47 (95% CI, 1.36-1.60) among patients with frequent exacerbations (≥2 treated exacerbations per year vs infrequent exacerbations).
  • Adjusted OR for incident T2DM, 1.73 (95% CI, 1.65-1.82) among patients receiving high-dose ICS (>800 mcg budesonide equivalent dose vs no ICS).

Limitations

• Retrospective observational cohort.