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

VTE Thrombosis Thrombus
VTE Thrombosis Thrombus
Corticosteroids should be used with caution in patients with diabetes and mitigating factors should be considered.

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.”

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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