Corticosteroids Linked With Risk for Fracture, VTE, Sepsis in Diabetes

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Vitamin D mitigated the risk for fracture in patients with diabetes who used corticosteroids.
Vitamin D mitigated the risk for fracture in patients with diabetes who used corticosteroids.

Patients with diabetes taking short-term oral corticosteroids (<30 days) are at a greater risk for fracture, venous thromboembolism (VTE), and sepsis than patients without diabetes who do not take these medications, according to a longitudinal study published in the Journal of Diabetes.

Researchers identified 327,452 patients who used short-term oral corticosteroids for <30 days during a 3-year period. Use data of oral corticosteroids, including betamethasone, dexamethasone, methylprednisolone, triamcinolone, prednisone, prednisolone, hydrocortisone, and cortisone, were taken from pharmacy files.

Patients with type 2 diabetes were more likely to take short-term corticosteroids compared with patients with type 1 diabetes (P <.001) and patients without diabetes (P <.001). Overall, patients with diabetes who took corticosteroids had a greater risk for fracture, sepsis, and VTE than patients without diabetes who were not taking the medication (P <.001). For VTE, the incidence risk ratio (IRR) was 3.62 (95% CI, 2.41-5.45) during the 5 to 30 days following corticosteroid use.

In addition, there was an increased risk for fractures during the 5 to 30 days following corticosteroid use (IRR 2.06; 95% CI, 1.52-2.80), with simultaneous ergocalciferol attenuating risk (IRR 1.13; 95% CI, 0.12-11.07). In addition, sepsis-related hospitalization risk increased with corticosteroid use (IRR 3.79; 95% CI, 2.05-7.01); however, concomitant statin therapy mitigated the risk.

Misclassification of diabetes cases may have occurred as researchers relied primarily on ICD-9-CM diagnosis codes and medication use.

Results from this trial suggest “that efforts to prevent adverse outcomes with oral corticosteroids may be better targeted to individuals with diabetes than those without…[and] patients with type 1 diabetes may particularly benefit because of their higher baseline risk.”

Reference

Rogers MAM, Lin P, Nallamothu BK, Kim C, Waljee AK. Longitudinal study of short-term corticosteroid use by working-age adults with diabetes mellitus: risks and mitigating factors [published online November 28, 2017]. J Diabetes. doi:10.1111/1753-0407.12631

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