Comorbid Diabetes and COPD Impact of corticosteroid use on diabetes complications

OBJECTIVEdTo identify if there is a dose-dependent risk of diabetes complications in patients treated with corticosteroids who have both diabetes and chronic obstructive pulmonary disorder (COPD). RESEARCH DESIGNANDMETHODSdA retrospective study of administrative claims data from the Australian Government Department of Veterans ’ Affairs, from 1 July 2001 to 30 June 2008, of diabetes patients newly initiated on metformin or sulfonylurea. COPD was iden-tified by dispensings of tiotropium or ipratropium in the 6 months preceding study entry. Total corticosteroid use (inhaled and systemic) in the 12months after study entry was determined. The outcome was time to hospitalization for a diabetes-related complication. Competing risks and Cox proportional hazard regression analyses were conducted with adjustment for a number of covariates. RESULTSdA total of 18,226 subjects with diabetes were identified, of which 5.9%had COPD. Of those with COPD, 67.2 % were dispensed corticosteroids in the 12 months from study entry. Stratification by dose of corticosteroids demonstrated a 94 % increased likelihood of hospitali-zation for a diabetes complication for those who received a total defined daily dose (DDD) o