title: Glucocorticoid treatment and impaired mood, memory and metabolism in people with diabetes: the Edinburgh Type 2 Diabetes Study.
abstract: OBJECTIVE
  Both type 2 diabetes and glucocorticoid therapy are highly prevalent. Although people with type 2 diabetes may be more susceptible to adverse effects of glucocorticoids, and it is recommended that glucocorticoid therapy is avoided for fear of worsening glycaemic control, the extent to which this advice is followed and the consequences when glucocorticoids are prescribed are poorly documented. The aim was to assess the characteristics of people with type 2 diabetes prescribed glucocorticoids in a real-world setting and to quantify resulting adverse effects.
  
  
  METHODS
  Cross-sectional cohort study.
  
  
  METHODS
  Cardiometabolic variables, body fat distribution, cognitive function and mood were studied in the 1066 participants of the Edinburgh Type 2 Diabetes Study, of whom 162 (15%) were taking systemic, topical or inhaled glucocorticoids.
  
  
  RESULTS
  Glucocorticoid therapy was more common in women and in smokers but was not avoided in patients with diabetic complications or cardiovascular risk factors. People taking glucocorticoids were more centrally obese with slightly higher HbA1c and total serum cholesterol but were no more likely to have hepatic steatosis or hypertension. Glucocorticoid treatment was associated with substantially lower mood and greater anxiety. Women taking glucocorticoid therapy were twice as likely to report depressive symptoms compared with those not taking treatment. Glucocorticoid therapy was also associated with poorer cognitive function among those with subclinical atherosclerosis, as indicated by low ankle-brachial pressure index.
  
  
  CONCLUSIONS
  Glucocorticoids are prescribed commonly for people with type 2 diabetes despite being associated with adverse indices of glycaemic control, cardiovascular risk factors, mood and cognitive function.
authors.affiliation: Endocrinology Unit, University/BHF Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh EH16 4TJ, UK. r.reynolds@ed.ac.uk
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Reynolds
authors.forename: Javier
authors.initials: J
authors.lastname: Labad
authors.forename: Alison V
authors.initials: AV
authors.lastname: Sears
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Williamson
authors.forename: Mark W J
authors.initials: MW
authors.lastname: Strachan
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Deary
authors.forename: Gordon D O
authors.initials: GD
authors.lastname: Lowe
authors.forename: Jackie F
authors.initials: JF
authors.lastname: Price
authors.forename: Brian R
authors.initials: BR
authors.lastname: Walker
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000097:blood / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects* / Q000627:therapeutic use; D044882:Glucose Metabolism Disorders / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D008875:Middle Aged; D019964:Mood Disorders / Q000097:blood / Q000139:chemically induced / Q000453:epidemiology*; D011446:Prospective Studies; D012606:Scotland / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D005938:Glucocorticoids