SELECTED ARTICLES FROM THE RECENT LITERATURE 2007

August 9, 2007

Effects of inhaled corticosteroids on glucose tolerance and insulin sensitivity in asthma and in COPD

Summary
Background- Systemic corticosteroid therapy can adversely affect glucose tolerance (GTT) and associated insulin sensitivity (IS). Does treatment with inhaled corticosteroids (ICS) have similar effects?

Findings – Canis et al of the Cerrahpasa School of Medicine compared the GTT and IS in a group of subjects with asthma and COPD before and after an 8 week course of ICS treatment (budesonide 400 microg bid). There was no significant difference in the GTT and IS in the asthmatic subjects before and after ICS treatment. However, there was a significant adverse alteration of the GTT and IS following ICS therapy in the COPD patients. The authors concluded that : 1) Differences in pathogenesis between asthma and COPD seem to offer the most plausible explanation for differences in carbohydrate metabolism achieved through ICS therapy; 2) the effect of an ICS on IS is associated not only with ICS dose, treatment period, age, and body mass index (BMI) but also with the severity of initial mucosal inflammation.

Reference
Adv Ther. 2007;24: 560-70

Editor's Comments
From my understanding of the results of this study, I am not sure that the authors have ruled out that the abnormalities associated with ICS therapy in the COPD but not in the asthmatic subjects may have been due to the generally older age of the COPD patients. The abnormalities in glucose tolerance associated with increasing age have been well described in the literature.

 

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