Increased risk of hospitalisation with corticosteroid use in patients with diabetes and COPD

Background: Corticosteroids are recommended as part of guideline therapies for the maintenance and treatment of acute exacerbations in chronic obstructive pulmonary disease (COPD). However, corticosteroid use is associated with decreased blood glucose control. Objectives: To determine if corticosteroid use results in an increased risk of diabetes - related hospitalisations in patients with diabetes and COPD. Methods: A retrospective study was undertaken on administrative claims data from the Department of Veterans' Affairs, Australia from 1st July 2000 - - 30th June 2008 of new users of metformin or sulfonylurea. COPD was defined as two dispensings of tiatropium or ipratropium in the six months preceding the first dispensing of an oral hypoglycaemic. Total corticosteroid use (inhaled and systemic) was measured by DDDs calculated over the 12 month period from study entry. The outcome was time to hospitalisation for a diabetes - related complication. Competing risks regression analyses were conducted with adjustment for a number of covariates. Results: A total of 24,220 new users of metformin or sulfonylurea were identified. 1,504 had COPD and of these, corticosteroids were used by 954. After 5 years of follow up, 20% of those with COPD and corticosteroid use had a diabetes - related hospitalisation. Stratification by dose of corticosteroids, demonstrated a 50% increased likelihood of hospitalisation for a diabetes - related complication for those who received a total DDD of ≥0.3 (SHR 1.50, 95% CI 1.01 - - 2.22, p