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World J Diabetes. Aug 15, 2023; 14(8): 1202-1211
Published online Aug 15, 2023. doi: 10.4239/wjd.v14.i8.1202
Impact of inhaled and intranasal corticosteroids on glucose metabolism and diabetes mellitus: A mini review
Kay Choong See
Kay Choong See, Department of Medicine, National University Hospital, Singapore 119228, Singapore
Author contributions: See KC collected the data, wrote the paper, read and approved the final manuscript.
Conflict-of-interest statement: The author reports no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kay Choong See, FCCP, FRCP, MBBS, MRCP, Adjunct Associate Professor, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Level 10 NUHS Tower Block, Singapore 119228, Singapore. mdcskc@nus.edu.sg
Received: February 11, 2023
Peer-review started: February 11, 2023
First decision: May 15, 2023
Revised: May 28, 2023
Accepted: July 11, 2023
Article in press: July 11, 2023
Published online: August 15, 2023
Processing time: 180 Days and 23.7 Hours
Abstract

Inhaled corticosteroids (ICS) and intranasal corticosteroids (INS) are the mainstays of treatment for chronic respiratory diseases like asthma, chronic obstructive pulmonary disease, and allergic rhinosinusitis. In addition, these localized forms of steroid therapy are generally considered to have fewer systemic side effects compared to long-term oral corticosteroids. However, concern and controversy remain over the impact of ICS and INS on the incidence and control of diabetes mellitus (DM). Given the widespread use of ICS and INS, even small individual effects on DM could lead to large consequences for the global popu-lation. Multiple large observational studies suggest that high dose ICS is associated with increased incident DM and worsened DM control, though the contribution of other risk factors is less certain. In addition, only two studies were done to investigate the association of INS and DM, with both studies demon-strating a short-term association of INS use with hyperglycemia. While more research evaluating the risk of ICS/INS for DM-related adverse events is needed, high doses of ICS/INS should be avoided when possible. The following strategies for ICS/INS dose minimization can be considered: Use of non-pharmacological measures (trigger avoidance, smoking cessation, vaccination to avoid infection), control of comorbid conditions, use of non-ICS-containing medications, inter-mittent rather than regular ICS dosing, and appropriate de-escalation of high ICS doses.

Keywords: Beclomethasone; Budesonide; Fluticasone; Glucocorticoids; Glucose; Hyperglycemia

Core Tip: Inhaled corticosteroids (ICS) and intranasal corticosteroids (INS) are the mainstays of treatment for chronic respiratory diseases like asthma, chronic obstructive pulmonary disease, and allergic rhinosinusitis. Multiple large observational studies suggest that high dose ICS is associated with increased incident diabetes mellitus (DM) and worsened DM control, though the contribution of other risk factors is less certain. In addition, only two studies were done to investigate the association of INS and DM, with both studies demonstrating a short-term association of INS use with hyperglycemia.