(9R)-9-chloro-11-17-dihydroxy-17-(2-hydroxy-1-oxoethyl)-10-13-16-trimethyl-6-7-8-11-12-14-15-16-octahydrocyclopenta[a]phenanthren-3-one and Diabetes-Mellitus

We determined the effect of high doses of inhaled beclomethasone dipropionate (2000 micrograms day-1 for two weeks) on the glucose tolerance test, insulin levels, fasting cholesterol and triglyceride concentrations in fourteen normal and ten elderly diet controlled diabetic patients, in a single blind, placebo controlled trial. No significant disturbance of glucose or lipid metabolism was found in either group. This study suggests that at this high dose, BDP does not exhibit significant disturbance of glucose and lipid metabolism after two weeks use.

Topics: Administration, Inhalation; Adult; Aged; Beclomethasone; Blood Glucose; Clinical Trials as Topic; Diabetes Mellitus; Female; Glucose Tolerance Test; Humans; Insulin; Lipids; Male; Single-Blind Method

There is evidence that large doses of inhaled corticosteroids lead to an increased risk of glaucoma, cataracts and other problems associated with oral corticosteroid use. However, no formal investigation so far has been conducted into the relationship between inhaled corticosteroids and diabetes.. Our nested case-control design studied the association between current use of inhaled corticosteroids and the risk of using antidiabetic medications among a cohort of 21 645 elderly subjects. We also investigated the possibility of a dose-response relationship in users of beclomethasone. Data were obtained from the medical and pharmaceutical databases of the Regie de l'assurance maladie du Québec.. Within the cohort, we identified 1494 cases and we selected 14 931 controls using density sampling. The unadjusted rate ratio (and 95% confidence interval, CI) for developing diabetes among current users of inhaled corticosteroids was 1.4 (1.2, 1.5). After adjusting for covariates, the rate ratio (95% CI) decreased to 0.9 (0.8, 1.1). The loss of statistical significance was due in large part to adjusting for the current use of oral corticosteroids. We also did not observe a statistically significant increase in risk among users of high-dose beclomethasone compared to nonusers, after adjusting for covariates.. Our results do not indicate an increased risk of diabetes among current users of inhaled corticosteroids.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Aged; Aged, 80 and over; Anti-Asthmatic Agents; Asthma; Beclomethasone; Case-Control Studies; Cohort Studies; Diabetes Mellitus; Dose-Response Relationship, Drug; Female; Humans; Male; Risk Factors

A 54-year-old woman complained of dyspnea, cough, and productive sputum. Auscultation detected a wheeze in the left and right lung fields. Chest x-ray and computed tomographic films showed non-segmental infiltration in the left upper lung field. Laboratory data revealed eosinophilia in peripheral blood and sputum, elevated levels of serum interleukin-5 (IL-5), airflow limitation, hypoxemia, and heightened airway sensitivity to methacholine (D min : 0.42 units). Bronchoalveolar lavage disclosed an increase in the total number of cells, a 32% increase in eosinophils, and a decreased CD 4/CD 8 ratio of 0.7. Transbronchial lung biopsy specimens revealed infiltrations of eosinophils in the alveolar and interstitial compartments. The histologic features of bronchial biopsy specimens included increased eosinophils in the submucosa and squamous metaplasia. In addition, blood glucose and HbA 1 c levels were elevated. Chronic eosinophilic pneumonia complicated by bronchial asthma and diabetes mellitus was diagnosed. Because the patient was diabetic, she was given suplatast tosilate to reduce the production of IL-5, and high-dose inhaled corticosteroid (beclometasone dipropionate, 1,600 mcg/day) instead of oral corticosteroid therapy. Her symptoms were relieved, peak expiratory flow rates increased, serum IL-5 levels became undetectable, airway sensitivity to methacholine decreased (D min : 4.64 units), and the radiographic abnormalities disappeared. Furthermore, treatment with beclomethasone dipropionate was progressively reduced to 1,200 mcg/day over the subsequent year without relapse. It was concluded that suplatast tosilate and high-dose inhaled corticosteroid therapy may be an effective alternative therapeutic approach to chronic eosinophilic pneumonia in some cases.

Topics: Administration, Inhalation; Anti-Asthmatic Agents; Arylsulfonates; Asthma; Beclomethasone; Chronic Disease; Diabetes Complications; Diabetes Mellitus; Female; Humans; Interleukin-5; Middle Aged; Pulmonary Eosinophilia; Sulfonium Compounds