Date of Award

2012

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department

Physician Assistant Studies

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE The objective of this selective EBM review is to determine whether or not inhaled corticosteroids (ICS) cause an increased risk for developing or worsening a patient’s diabetes mellitus (DM).

STUDY DESIGN Review of three English language primary studies published in 1993, 2009 and 2010.

DATA SOURCES A nested case-control analysis, a randomized control trial and a prospective randomized, doubleblind, double-dummy, placebo-controlled, crossover investigation comparing the onset and/or progression of diabetes mellitus in patients using ICS were found using Ovid MEDLINE, PubMed, and Cochrane databases.

OUTCOMES MEASURED Incidence or progression of diabetes was measured using a combination of oral glucose tolerance test, serum insulin levels, HGbA1c levels, and fasting glucose levels.

RESULTS Faul had 70% of patients that experienced some increase in HGbA1c levels, but none that were statistically significant. Kiviranta had very slight increases in blood glucose when compared to the patient’s baseline measurements. Suissa had a 34% increase in the onset or progression to insulin use of diabetic patients.

CONCLUSIONS While all of the studies showed an increase in the incidence or progression of diabetes in patients taking ICS, none of the increases were significant enough to preclude diabetics from taking ICS as needed. Careful monitoring of a patient with diabetes needing an ICS is warranted to prevent loss of diabetes control. Additionally, a baseline HGbA1c level on a patient newly prescribed an ICS might be beneficial.

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