title: Glucocorticoid-induced hyperglycaemia in respiratory disease: a systematic review and meta-analysis.
abstract: The relative risk of glucocorticoid-induced hyperglycaemia is poorly quantified. We undertook a meta-analysis to estimate the association between glucocorticoid treatment and hyperglycaemia, overall and separately in individuals with and without diabetes and underlying respiratory disease. We searched electronic databases for clinical trials of adults randomized to either glucocorticoid treatment or placebo. Eight articles comprising 2121 participants were identified. We performed a random effects meta-analysis to determine relative risks for the associations between glucocorticoid use and both hyperglycaemia and starting hypoglycaemic therapy. In all individuals, the relative risk of hyperglycaemia comparing glucocorticoid treatment with placebo was 1.72 [95% confidence interval (CI) 1.50-2.04; p < .001]. The relative risks in individuals with and those without diabetes were 2.10 (95% CI 0.92-5.02; p = .079) and 1.50 (95% CI 0.79-2.86; p = .22), respectively. In all individuals, the relative risk of hyperglycaemia requiring initiation of hypoglycaemic therapy, comparing glucocorticoid treatment with placebo, was 1.73 (95% CI 1.40-2.14; p < .001). In conclusion, glucocorticoid therapy increases the risk of hyperglycaemia in all individuals with underlying respiratory disease but not when diabetic status is analysed separately.
authors.affiliation: Department of Medicine, Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: S
authors.initials: S
authors.lastname: Breakey
authors.affiliation: MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Cambridge, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Sharp
authors.affiliation: Department of Medicine, Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: A I
authors.initials: AI
authors.lastname: Adler
authors.affiliation: Department of Medicine, Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: B G
authors.initials: BG
authors.lastname: Challis
mesh_terms: D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy / Q000453:epidemiology*; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D012140:Respiratory Tract Diseases / Q000188:drug therapy*; D012306:Risk
chemical_list: D005938:Glucocorticoids; D007004:Hypoglycemic Agents
keywords: endocrine therapy; glycaemic control; meta-analysis