Saeed Mohamad Isam, Eklöf Josefin, Achir Imane, Sivapalan Pradeesh, Meteran Howraman, Løkke Anders, Biering-Sørensen Tor, Knop Filip Krag, Jensen Jens-Ulrik Staehr
Section of Respiratory Medicine, Department of Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.
Department of Internal Medicine, Zealand Hospital, University of Copenhagen, Roskilde, Denmark.
Diabetes Obes Metab. 2020 Aug;22(8):1348-1356. doi: 10.1111/dom.14040. Epub 2020 Apr 19.
To determine the risk of type 2 diabetes onset associated with accumulated inhaled corticosteroids (ICS) dose during the previous year in patients with chronic obstructive pulmonary disease (COPD).
We conducted a nationwide observational cohort study based on data from patients with COPD between 1 January 2010 and 31 December 2017 extracted from Danish health databases. Patients were followed for 7 years, until death or a type 2 diabetes event. A propensity-matched Cox model and an adjusted Cox proportional hazards model (stratified on body mass index [BMI]) were used to estimate the hazard ratio (HR) for new-onset type 2 diabetes.
A total of 50 148 patients with COPD were included, 3566 (7.1%) of whom had a type 2 diabetes event. During the previous year before study entry, 35 368 patients (70.5%) used ICS. The propensity-matched Cox model (N = 33 466) showed an increased risk of type 2 diabetes, which progressed with increasing accumulated ICS dose (low-ICS: HR 1.076, confidence interval [CI] 1.075-1.077, P < .0001; medium-ICS: HR 1.106, CI 1.105-1.108, P < .0001; high-ICS: HR 1.150, CI 1.148-1.151, P < .0001), compared with no ICS use. Results were confirmed in the adjusted Cox analysis on the entire study population, but only for patients with BMI <30 kg/m .
In patients with COPD, ICS use was associated with a moderate dose-dependent increase in the occurrence of type 2 diabetes.
确定慢性阻塞性肺疾病（COPD）患者前一年吸入性糖皮质激素（ICS）累积剂量与2型糖尿病发病风险之间的关系。
我们基于2010年1月1日至2017年12月31日从丹麦健康数据库中提取的COPD患者数据进行了一项全国性观察队列研究。对患者进行7年随访，直至死亡或发生2型糖尿病事件。采用倾向匹配Cox模型和校正Cox比例风险模型（按体重指数[BMI]分层）来估计2型糖尿病新发的风险比（HR）。
共纳入50148例COPD患者，其中3566例（7.1%）发生2型糖尿病事件。在研究入组前一年，35368例患者（70.5%）使用了ICS。倾向匹配Cox模型（N = 33466）显示2型糖尿病风险增加，且随着ICS累积剂量增加而升高（低剂量ICS：HR 1.076，置信区间[CI] 1.075 - 1.077，P <.0001；中等剂量ICS：HR 1.106，CI 1.105 - 1.108，P <.0001；高剂量ICS：HR 1.150，CI 1.148 - 1.151，P <.0001），与未使用ICS者相比。在对整个研究人群进行的校正Cox分析中证实了该结果，但仅适用于BMI < 30 kg/m²的患者。
在COPD患者中，使用ICS与2型糖尿病发生率呈中度剂量依赖性增加相关。
