Impact of inhaled and intranasal corticosteroids on glucose metabolism and diabetes mellitus: A mini review

Table 3 Methods to reduce the impact of inhaled corticosteroid and intranasal corticosteroid on glucose metabolism and diabetes mellitus

Strategy	Methods
Minimize ICS doses	Use non-pharmacological measures (e.g., trigger avoidance, smoking cessation, vaccination to avoid respiratory infections) to optimize disease control and reduce the need for high dose ICS[2]
	Manage comorbid conditions to optimize disease control (e.g., management of obesity, OSA, heart failure, anxiety, depression) and reduce the need for high dose ICS. Consider using the “treatable traits” approach for holistic management of chronic respiratory diseases[30]
	Use long-acting bronchodilators to reduce the need for high dose ICS[2]
	Ensure good inhaler technique (or use valved holding chamber) to improve lung delivery and effectiveness of ICS, reducing the need for high dose ICS[2]
	Consider intermittent formoterol-ICS therapy rather than regular ICS for asthma[31]
	Actively step-down regular ICS dosing, including changing regular to intermittent ICS use, by clinical assessment[31]
	Actively step-down regular ICS dosing by measuring FENO in asthma[32]
	Actively step-down or step-off ICS if peripheral eosinophil count < 300/μL in well-controlled COPD[2]
Minimize INS doses	Use non-pharmacological measures (e.g., trigger avoidance, smoking cessation, vaccination to avoid respiratory infections) to optimize disease control and reduce the need for high dose INS[56]
	Use non-steroidal medications like intranasal antihistamines to reduce the need for high dose INS[56]
	Ensure good intranasal delivery technique to improve effectiveness of INS, reducing the need for high dose INS
	Actively step-down regular INS dosing, including changing regular to intermittent INS use, following clinical assessment, e.g., as-needed intranasal corticosteroids for seasonal allergic rhinitis[57]
Maintain hepatic inactivation of ICS and INS	Avoid strong CYP450 3A4 inhibitors like clarithromycin, itraconazole, ketoconazole, and voriconazole[3,9]
Minimize risk of hyperglycemia	Avoid long-term oral corticosteroids[18]
	Weight management for overweight and obese patients[58]
	Ensure good glycemic control for diabetic patients[58]

COPD: Chronic obstructive pulmonary disease; DM: Diabetes mellitus; FENO: Fractional exhaled nitric oxide; ICS: Inhaled corticosteroid; INS: Intranasal corticosteroid; OSA: Obstructive sleep apnea.