Hyperglycemia risk increased in COPD patients taking glucocorticoids
A systematic review and meta-analysis found that being treated with systemic glucocorticoids for chronic obstructive pulmonary disease (COPD) was associated with more than twofold higher risk for new-onset hyperglycemia versus no glucocorticoid treatment.
Patients with chronic obstructive pulmonary disease (COPD) who are taking glucocorticoids may be at higher risk for hyperglycemia, according to a recent study.
Researchers performed a systematic review and meta-analysis of randomized controlled trials and observational studies published until Nov. 9, 2023, to evaluate the prevalence of and risk for glucocorticoid-induced hyperglycemia in patients with COPD with or without diabetes at baseline. Systemic glucocorticoid exposure was defined as the equivalent of at least 5 mg of prednisolone per day for at least three days, and hyperglycemia was defined as a blood glucose level above a study-specific cutoff. Random-effects meta-analysis was used to calculate a pooled prevalence estimate of glucocorticoid-induced hyperglycemia, and prevalence was reported as the proportion who developed hyperglycemia among all who had systemic glucocorticoid exposure during follow-up. The study results were published Dec. 6 by Diabetic Medicine.
Overall, 18 studies including 3,642 people were included in the analysis. Eight of the studies were randomized controlled trials, and 10 were observational studies. Median study sample size at baseline was 132 patients; median age at baseline across studies was 69 years. A total of 3,125 patients received systemic glucocorticoids and 1,189 developed hyperglycemia. The pooled prevalence of glucocorticoid-induced hyperglycemia was 38.6% (95% CI, 29.9% to 47.9%), with significant heterogeneity partially explained by differences in study design. The pooled relative risk for hyperglycemia with glucocorticoid exposure, based on eight studies of 1,034 patients, was 2.39 (95% CI, 1.51 to 3.78).
The researchers noted that their results may have been affected by publication bias and that they were unable to stratify relative risk for new-onset glucocorticoid-associated hyperglycemia by baseline diabetes status, among other limitations.
They concluded that their findings suggest a high prevalence of glucocorticoid-induced hyperglycemia in patients with COPD and that systemic glucocorticoid therapy significantly increases hyperglycemia risk. “Clinicians providing care for people with COPD who are treated with systemic glucocorticoids should consider measuring blood glucose before starting systemic glucocorticoids and throughout the treatment course to detect and manage [glucocorticoid-induced hyperglycemia],” the authors wrote.