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

Authors Aldibbiat AM, Al-Sharefi A

Received 28 October 2019

Accepted for publication 21 February 2020

Published 16 March 2020 Volume 2020:15 Pages 567—574


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Richard Russell

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, UK

Correspondence: Ali M Aldibbiat
Dasman Diabetes Institute, Sharq, Block 3, P.O. Box 1180, Dasman 15462, Kuwait
Tel +965 2224 2999 Ext. 2214
Fax +965 2249 2436

Abstract: 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

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