Corticosteroid-induced Diabetes in Patients With Chronic Obstructive Pulmonary Disease

In Brief Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity in the Western world. Patients with COPD are prone to acute exacerbation that may cause a substantial decline in functional status, hospitalization, and even death. The study group, Systemic Corticosteroids in Chronic Obstructive Pulmonary Disease Exacerbations, randomized 271 patients who were hospitalized with a COPD exacerbation. Short treatment with corticosteroids—intravenous methylprednisolone 125 mg, every 6 h, for 3 days, followed by oral prednisone starting at 60 mg daily, with a tapering dose over 2 weeks—significantly improved the FEV1 during the first 3 days of hospitalization, shortened the length of initial hospital stay, had the lowest rate of therapeutic adverse effects, but had no significant effect on mortality rate. Based on the above study, and after a systemic review of the literature, experts on COPD published the guidelines for diagnosis and treatment of acute exacerbation of COPD. According to those, the systemic glucocorticoids are now a standard therapy for acute exacerbations of COPD. However, corticosteroids may induce hyperglycemia, and a balance between benefit and risk must be achieved. Hyperglycemia is associated with poor outcomes in patients admitted to hospital with acute exacerbations of chronic obstructive pulmonary disease. Systemic glucocorticoids are now a standard therapy for severe exacerbations of chronic obstructive pulmonary disease, but they may cause hyperglycemia via different mechanisms. The balance between these issues is described in our article.