The effect of an inhaled corticosteroid on glucose control in type 2 diabetes.
OBJECTIVE
To determine the effect of inhaled corticosteroid (ICS) therapy on glucose control in adults with type 2 diabetes mellitus and coexisting asthma or chronic obstructive pulmonary disease (COPD).


METHODS
A prospective randomized, double-blind, double-dummy placebo-controlled, crossover investigation of inhaled steroids and oral leukotriene blockers.


METHODS
A United States Department of Veterans Affairs Health Care System outpatient setting.


METHODS
Adults with type 2 diabetes and asthma or COPD.


METHODS
Subjects (n=12) were randomized to receive either inhaled fluticasone propionate (440 microg twice daily) and oral placebo, or inhaled placebo and oral montelukast (10 mg/day). After 6 weeks, subjects were switched to the opposite therapy for 6 weeks. The primary outcome measure was the change in the percentage of glycosylated hemoglobin (%HbA1c) at 6 weeks relative to the baseline value.


RESULTS
Ten patients completed the study. The difference between the mean within-subject changes in %HbA1c associated with 6-week periods of fluticasone and the mean changes associated with montelukast therapy was small but statistically significant (mean difference=0.25; P<0.025). Neither fluticasone nor oral montelukast therapy for 6 weeks led to a significantly different mean % HbA1c compared with the relevant baseline (mean differences=0.11 and -0.14, respectively).


CONCLUSIONS
The absence of a clinically significant within-subject difference in the changes in %HbA1c associated with fluticasone versus oral montelukast therapy, or between either therapy or baseline does not warrant recommending changes in therapy for asthma or diabetes in patients with these co-morbid conditions. However, we suggest that clinicians carefully monitor blood glucose control when diabetic patients initiate ICS, especially with higher dosages.
Faul
John L
JL
Department of Respiratory Medicine, Connolly Hospital, Dublin, Ireland.
Wilson
Sandra R
SR
Chu
James W
JW
Canfield
James
J
Kuschner
Ware G
WG
D000085:Acetates / Q000008:administration & dosage; D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage; D001993:Bronchodilator Agents / Q000008:administration & dosage; D018592:Cross-Over Studies; D003521:Cyclopropanes; D048909:Diabetes Complications / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D004311:Double-Blind Method; D000068298:Fluticasone; D005947:Glucose / Q000378:metabolism*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010919:Placebos; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy*; D011804:Quinolines / Q000008:administration & dosage; D013440:Sulfides; D016896:Treatment Outcome
D000085:Acetates; D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D003521:Cyclopropanes; D000068298:Fluticasone; D005947:Glucose; D006442:Glycated Hemoglobin; D010919:Placebos; D011804:Quinolines; D013440:Sulfides; C517652:hemoglobin A1c protein, human; C093875:montelukast