Do Benefits Outweigh Risks for Corticosteroid Therapy in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in People with Diabetes Mellitus?

• Main Authors: Aldibbiat AM, Al-Sharefi A
• Format: Article
• Language: English
• Published: Dove Medical Press 2020-03-01
• Series: International Journal of COPD
• Subjects: copd; acute exacerbation of copd; corticosteroids; metabolic syndrome; hyperglycemia; diabetes mellitus
• Online Access: https://www.dovepress.com/do-benefits-outweigh-risks-for-corticosteroid-therapy-in-acute-exacerb-peer-reviewed-article-COPD

Ali M Aldibbiat,1,2 Ahmed Al-Sharefi3 1Dasman Diabetes Institute, Kuwait City, Kuwait; 2Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; 3Metabolic and Diabetes Unit, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UKCorrespondence: Ali M AldibbiatDasman Diabetes Institute, Sharq, Block 3, P.O. Box 1180, Dasman 15462, KuwaitTel [phone] Ext. 2214Fax [phone]Email [e-mail]: Chronic obstructive pulmonary disease (COPD) and diabetes mellitus (DM) are chronic health conditions with significant impacts on quality and extent of life. People with COPD and DM appear to have worse outcomes in each of the comorbid conditions. Treatment with corticosteroids in acute exacerbation of COPD (AECOPD) has been shown to reduce treatment failure and exacerbation relapse, and to shorten length of hospital stay, but not to affect the inexorable gradual worsening of lung function. Treatment with corticosteroids can lead to a wide spectrum of side effects and complications, including worsening hyperglycemia and deterioration of diabetes control in those with pre-existing DM. The relationship between COPD and DM is rather complex and accumulating evidence indicates a distinct phenotype of the comorbid state. Several randomized controlled trials on corticosteroid treatment in AECOPD excluded people with DM or did not report on outcomes in this subgroup. As such, the perceived benefits of corticosteroids in AECOPD in people with DM have not been validated. In people with COPD and DM, the detrimental side effects of corticosteroids are guaranteed, while the benefits are not confirmed and only presumed based on extrapolation from the general COPD population. Therefore, the potential for harm when prescribing corticosteroids for AECOPD in people with DM cannot be excluded.Keywords: COPD, acute exacerbation of COPD, corticosteroids, metabolic syndrome, hyperglycemia, diabetes mellitus