ArticleNPJ primary care respiratory medicine2019
Inhaled corticosteroids in COPD and onset of type 2 diabetes and osteoporosis: matched cohort study.
Article in NPJ primary care respiratory medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 5 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
29 citing papers in PubMed, 5 syntheses or guidelines pooled it, 46 citations in OpenAlex.
- Dose of Inhaled Corticosteroid in Chronic Obstructive Pulmonary Disease and Risks of Osteoporosis or Fracture-A Systematic Review and Meta-Analysis.The clinical respiratory journal · 2025Pooled it
- Evaluating inhaled corticosteroids' impact on osteoporosis and fracture risk in COPD patients: a real-world evidence-based systematic review and meta-analysis.Frontiers in medicine · 2025Pooled it
- Pooled it
- Association between ICS use and risk of hyperglycemia in COPD patients: systematic review and meta-analysis.Respiratory research · 2021Pooled it
- Systematic review on long-term adverse effects of inhaled corticosteroids in the treatment of COPD.European respiratory review : an official journal of the European Respiratory Society · 2021Pooled it
- Polypharmacy and Bone Health in Patients with Type 2 Diabetes Mellitus: A Narrative Review.Journal of bone metabolism · 2026Article
- De-implementation of inappropriate inhaled corticosteroid use in patients with COPD in general practice, results of a mixed methods study.NPJ primary care respiratory medicine · 2025Article
- Article
- Review
- Adverse Outcomes Associated With Inhaled Corticosteroid Use in Individuals With Chronic Obstructive Pulmonary Disease.Annals of family medicine · 2025Article
- Chronic Obstructive Pulmonary Disease and Type 2 Diabetes Mellitus: Complex Interactions and Clinical Implications.Journal of clinical medicine · 2025Review
- Review
- Is It Time for a New Algorithm for the Pharmacotherapy of Steroid-Induced Diabetes?Journal of clinical medicine · 2024Review
- Exacerbation-like events in the 12 months prior to identification of chronic respiratory conditions in a primary care population.Respiratory medicine · 2024Article
- Chronic Obstructive Pulmonary Disease and Osteoporosis: A Two-Sample Mendelian Randomization Analysis.Chronic obstructive pulmonary diseases (Miami, Fla.) · 2024Article
- Inhaled corticosteroids andBMJ open respiratory research · 2024Observational
- Inhaled Corticosteroids in Subjects with Chronic Obstructive Pulmonary Disease: An Old, Unfinished History.Biomolecules · 2024Review
- Managing Osteoporosis in COPD.Endocrine, metabolic & immune disorders drug targets · 2024Review
- Hyperglycaemia and Chronic Obstructive Pulmonary Disease.Diagnostics (Basel, Switzerland) · 2023Review
- Oral corticosteroid use and sarcopenia-related traits in older people with chronic airway disease: a population-based study.ERJ open research · 2023Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 8 institutions in 10 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Some studies suggest an association between onset and/or poor control of type 2 diabetes mellitus and inhaled corticosteroid (ICS) therapy for chronic obstructive pulmonary disease (COPD), and also between increased fracture risk and ICS therapy; however, study results are contradictory and these associations remain tentative and incompletely characterized. This matched cohort study used two large UK databases (1983-2016) to study patients (≥ 40 years old) initiating ICS or long-acting bronchodilator (LABD) for COPD from 1990-2015 in three study cohorts designed to assess the relation between ICS treatment and (1) diabetes onset (N = 17,970), (2) diabetes progression (N = 804), and (3) osteoporosis onset (N = 19,898). Patients had ≥ 1-year baseline and ≥ 2-year outcome data. Matching was via combined direct matching and propensity scores. Conditional proportional hazards regression, adjusting for residual confounding after matching, was used to compare ICS vs. LABD and to model ICS exposures. Median follow-up was 3.7-5.6 years/treatment group. For patients prescribed ICS, compared with LABD, the risk of diabetes onset was significantly increased (adjusted hazard ratio 1.27; 95% CI, 1.07-1.50), with overall no increase in risk of diabetes progression (adjusted hazard ratio 1.04; 0.87-1.25) or osteoporosis onset (adjusted hazard ratio 1.13; 0.93-1.39). However, the risks of diabetes onset, diabetes progression, and osteoporosis onset were all significantly increased, with evident dose-response relationships for all three outcomes, at mean ICS exposures of 500 µg/day or greater (vs. < 250 µg/day, fluticasone propionate-equivalent). Long-term ICS therapy for COPD at mean daily exposure of ≥ 500 µg is associated with an increased risk of diabetes, diabetes progression, and osteoporosis.
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Registered trials
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