A RESPIRATORY expert has called for patients with chronic airway inflammation to be screened for type 2 diabetes following a study which showed they are at increased risk of the disease.

Thoracic physician Professor Christine Jenkins, Clinical Professor of Medicine at the University of Sydney, also warned doctors to be cautious about prescribing unnecessary doses of corticosteroids when managing patients with asthma or chronic obstructive pulmonary disease (COPD).

She was commenting on the results of a study, published in Diabetes Research and Clinical Practice involving a cohort of 38 570 women from the Women’s Health Study.(1)

The women, aged 45 years or more, were free of cardiovascular disease and cancer at baseline, and free of diabetes at baseline and in the first 12 months.

However, during a median follow-up of 12.2 years, 2472 cases of type 2 diabetes were reported.

Women with asthma had a 37% increased risk of diabetes, and those with COPD, including emphysema, chronic bronchitis and bronchiectasis, without asthma had a 38% increased risk.

The risks were independent of traditional diabetes risk factors including age, smoking, physical activity, BMI, alcohol intake, hormone replacement therapy and menopausal status.

The authors said their results indicated chronic airway inflammation might contribute to the pathogenesis of diabetes.

Professor Jenkins said given the prevalence of asthma and COPD in Australia, a 38% increased risk of diabetes meant such patients should be screened.

“If you have poorly controlled airways disease or poorly controlled diabetes, is that going to have a negative effect on the other disease? I think the answer to that would be yes,” she said.

“Given the fact that oral steroids are a further aggravating factor for hyperglycaemia in diabetes, it would behove you to try to fine tune the management of asthma or COPD with inhaled medications and rehabilitation and physical activity.”

She said this would maximise the chances of the patient maintaining good quality of life and being free of exacerbations without the need for oral corticosteroids.

Professor Jenkins said up to 20% of adults in Australia were thought to have an obstructive airways disease of some type.

The fascinating part of the data was that the increased risk appeared to be independent of other known risk factors for diabetes, she said.

Diabetes expert Professor Stephen Colagiuri, Professor of Metabolic Health at the University of Sydney, said it was important for clinicians to be aware of the link.

“Certainly, if people have other risk factors for diabetes and COPD or asthma, then it should encourage screening for diabetes more actively,” he said.

Such patients should be advised to take more care with activities such as diet, physical activity and other lifestyle changes that minimised their risk of diabetes.

A drawback of the study was that it did not assess the use of corticosteroids, Professor Colagiuri said.

1. Diabetes Research and Clinical Practice 2010. doi:10.1016/j.diabres.2010.09.010.


Posted 18 October 2010

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