Effect of ICS on glycaemic control in patients with COPD and comorbid type 2 diabetes: Historical case-matched cohort study

Introduction: Type 2 diabetes mellitus (T2DM) is a common comorbidity of COPD. ICS treatment may be associated with reduced glycaemic control and increased risk of diabetic complications. Aim: To assess the effects of ICS on diabetes control in patients (pts) with COPD and T2DM. Methods: 2 UK primary care databases of >11 million pts were searched (2008- 2012) for pts with COPD and T2DM receiving ICS/non-ICS therapy. Pts were matched 1:1 for age, sex, body mass index, baseline HbA1c, COPD severity and medications. Primary endpoint: HbA1c (change from baseline) during the 12-18- month observation period. A subgroup analysis was conducted in pts with mild to moderate COPD (GOLD A+B), for whom ICS are not recommended by GOLD. Data were analysed using a generalised linear model with an identity link function and normal distribution; potential confounders were analysed for collinearity using Spearman's correlation coefficients. Results: 682 pts matched per arm; mean age 70 years; 73% men; 95% current or ex-smokers. Pts receiving ICS had a significantly greater increase in HbA1c vs non-ICS pts, notably for GOLD A+B groups. Higher cumulative ICS doses were associated with loss of glycaemic control (Table). (Table presented) Conclusions: ICS therapy for COPD is associated with reduced glycaemic control. Risk/benefit analyses of ICS in COPD should be considered, especially in pts with T2DM.