- © 2009 Marshfield Clinic
The Effect of an Inhaled Corticosteroid on Glucose Control in Type 2 Diabetes
- John L. Faul, MD,
- Sandra R. Wilson, PhD,
- James W. Chu, MD,
- James Canfield, BS and
- Ware G. Kuschner, MD
- John L. Faul, MD, Department of Respiratory Medicine Connolly Hospital, Dublin, Ireland
- Sandra R. Wilson, PhD, Palo Alto Medical Foundation, Research Institute, Palo Alto, California, USA and Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, California, USA
- James W. Chu, MD, Division of Endocrinology and Metabolism, Stanford University School of Medicine, Palo Alto, California, USA
- James Canfield, BS, Pulmonary Section, Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA
- Ware G. Kuschner, MD, Division of Pulmonary and Critical Care Medicine, Stanford University, Palo Alto, California, USA and Pulmonary Section, Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA
- Corresponding Author:
Ware G. Kuschner, MD, U.S. Department of Veterans Affairs, Palo Alto Health Care System, 3801 Miranda Avenue, Mail Code: 111P, Palo Alto, CA, 94304, Tel: 650-493-5000, ext. 63544, Fax: 650-852-3276, Email: kuschner{at}stanford.edu
Abstract
Objective: To determine the effect of inhaled corticosteroid (ICS) therapy on glucose control in adults with type 2 diabetes mellitus and coexisting asthma or chronic obstructive pulmonary disease (COPD).
Design: A prospective randomized, double-blind, double-dummy placebo-controlled, crossover investigation of inhaled steroids and oral leukotriene blockers.
Setting: A United States Department of Veterans Affairs Health Care System outpatient setting.
Participants: Adults with type 2 diabetes and asthma or COPD.
Methods: Subjects (n=12) were randomized to receive either inhaled fluticasone propionate (440 μg twice daily) and oral placebo, or inhaled placebo and oral montelukast (10 mg/day). After 6 weeks, subjects were switched to the opposite therapy for 6 weeks. The primary outcome measure was the change in the percentage of glycosylated hemoglobin (%HbA1c) at 6 weeks relative to the baseline value.
Results: Ten patients completed the study. The difference between the mean within-subject changes in %HbA1c associated with 6-week periods of fluticasone and the mean changes associated with montelukast therapy was small but statistically significant (mean difference=0.25; P<0.025). Neither fluticasone nor oral montelukast therapy for 6 weeks led to a significantly different mean % HbA1c compared with the relevant baseline (mean differences=0.11 and −0.14, respectively).
Conclusion: The absence of a clinically significant within-subject difference in the changes in %HbA1c associated with fluticasone versus oral montelukast therapy, or between either therapy or baseline does not warrant recommending changes in therapy for asthma or diabetes in patients with these co-morbid conditions. However, we suggest that clinicians carefully monitor blood glucose control when diabetic patients initiate ICS, especially with higher dosages.
