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Short-term corticosteroids increase risk for adverse events in diabetes

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December 22, 2017

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Adults with diabetes taking short-term oral corticosteroids experienced an increase in the risk for adverse events, though the risk was low and often mitigated by concomitant use of preventative medications, according to researchers.

“Guidelines for diabetes management include recommendations for careful monitoring of blood glucose when beginning the use of oral corticosteroids and for caution when insulin dosing corrections are made to compensate for the anticipated hyperglycemia. … Aside from hyperglycemia, the pleiotropic side effects of long-term oral corticosteroid use are well-recognized,” Mary A.M. Rogers, PhD, MS, associate professor of medicine at the University of Michigan, and colleagues wrote. “Use for short periods has been generally considered safe, but recently has been implicated in risk, albeit at rather low frequencies. Because adverse events may occur infrequently, it is not always possible to evaluate such risks within the context of a randomized controlled trial due to low statistical power.”

The researchers performed a longitudinal study of 1,548,945 patients aged 18 to 64 years who received insurance from a large national health insurer. Data were collected between 2012 and 2014. Rogers and colleagues calculated incidence rate ratios for adverse events using conditional Poisson regression.

Nearly one-fourth of patients with type 2 diabetes used short-term corticosteroids (23.9%), the researchers reported, compared with 20.8% of those with type 1 diabetes and 20.9% of patients without diabetes (P < .001). Patients with diabetes had a greater baseline risk for sepsis, fracture and venous thromboembolism (P < .001).

Rogers and colleagues reported that the combined effect of using corticosteroids while having diabetes was greater than the sum of either effect alone (synergy index, 1.17 for fracture; 1.23 for VTE; 1.3 for sepsis).

In the 5 to 30 days following corticosteroid use, the IRR for VTE was 3.62 (95% CI, 2.41-5.45). Although fractures rose following use of corticosteroids (IRR = 2.06; 95% CI, 1.52-2.8), concomitant ergocalciferol mitigated fracture risk (IRR = 1.13; 95% CI, 0.12-11.07), the researchers reported. Risk for hospitalization with sepsis also rose (IRR = 3.79; 95% CI, 2.05-7.01), but use of concomitant statins mitigated the risk.

“We conclude that the use of oral corticosteroids for short durations is common in patients with diabetes and is associated with an elevated (but modest) risk of fracture, venous thromboembolism and hospitalization for sepsis,” the researchers wrote. “The addition of ergocalciferol to prevent fractures and the addition of statins to prevent hospitalization for sepsis should be investigated in randomized trials, particularly in patients with diabetes who use corticosteroids.” – by Andy Polhamus

Disclosures: The authors report no relevant financial disclosures.