Effects of inhaled budesonide on insulin sensitivity in nondiabetic patients with asthma and chronic obstructive pulmonary disease
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In the study reported here, investigators explored the following: (1) the effects of inhaled corticosteroid (ICS) therapy on insulin sensitivity (IS) (the Homeostatic Model Assessment-Insulin Resistance [HOMA-IR] Index, which has never been used before in nondiabetic patients with asthma and chronic obstructive pulmonary disease [COPD], was used in this investigation); and (2) differences and similarities between asthma and COPD groups. A total of 12 patients with asthma and 6 with COPD who were not previously treated with oral corticosteroids or ICSs were treated with budesonide, 400 μg twice daily for 8 wk, via dry powder inhaler through the Aerolizer. Pretreatment and posttreatment values were recorded for forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, C-reactive protein (CRP), blood glucose, serum insulin levels, area under the curve (AUC) for glucose and insulin in an oral glucose tolerance test (OGTT), and HOMA-IR Index. The trapezoid technique, the formula for HOMA-IR, and Wilkinson, Mann-Whitney U, and t tests were used. In the group of patients with asthma, posttreatment values for the HOMA-IR Index, glucose, and insulin at all time points during OGTT and AUC for glucose and AUC for insulin were not statistically different compared with pretreatment values. In patients with COPD who had been given ICS therapy, however, the second hour glucose level during OGTT increased significantly compared with pretreatment values (P=.46). Pretreatment and posttreatment second hour insulin values and posttreatment AUC for glucose were significantly higher in the COPD group than in the asthma group (P=.047,P=.044, andP=.031, respectively). A moderate positive correlation was noted between the percentage of difference in FEV1 and the change in HOMA-IR (pretreatment mean value of HOMA-IR±standard deviation [SD], 2.7±2.6) in asthmatic patients as the result of therapy (r=0.50,P=.138). Investigators concluded the following: (1) Differences in pathogenesis between asthma and COPD seem to offer the most plausible explanation for differences in carbohydrate metabolism achieved through ICS therapy; (2) the effect of an ICS on IS is associated not only with dose, treatment period, age, and body mass index (BMI) but also with the severity of initial mucosal inflammation; and (3) as a result of improvements in respiratory function noted after treatment had been given, IS was increased in asthmatic patients.
- Ankerst J, Persson G, Weibull E. Tolerability of a high dose of budesonide/formoterol in a single inhaler in patients with asthma.Pulm Pharmacol Ther. 2003; 16: 147–151. CrossRef
- Faul JF, Cormican LJ, Tormey V, Tormey W, Burke C. Deteriorating diabetic control associated with high-dose inhaled budesonide.Eur Respir J. 1999; 14: 242–243. CrossRef
- Kiviranta K, Turpeinen M. Effect of eight months of inhaled beclomethasone dipropionate and budesonide on carbohydrate metabolism in adults with asthma.Thorax. 1993; 48: 974–978.
- Turpeinen M, Sorva R, Juntunen-Backman K. Changes in carbohydrate and lipid metabolism in children with asthma inhaling budesonide.J Allergy Clin Immunol. 1991; 88: 384–389. CrossRef
- Ebden P, McNally P, Samanta A, Fancourt GJ. The effects of high dose inhaled beclomethasone dipropionate on glucose and lipid profiles in normal and diet controlled diabetic subjects.Respir Med. 1989; 83: 289–291. CrossRef
- Kruszynska YT, Greenstone M, Home PD, Cooke NJ. Effect of high dose inhaled beclomethasone dipropionate on carbohydrate and lipid metabolism in normal subjects.Thorax. 1987; 42: 881–884.
- Yernault JC, Leclercq R, Schandevyl W, Virasoro E, De Coster A, Copinschi G. The endocrinometabolic effects of beclomethasone dipropionate in asthmatic patients.Chest. 1977; 71: 698–702. CrossRef
- Rewers M, Zaccaro D, D’Agostino R, Haffner S, Saad MF. Insulin sensitivity, insulinemia, and coronary artery disease: the insulin resistance atherosclerosis study.Diabetes Care. 2004; 27: 781–787. CrossRef
- Després JP, Lamarche B, Mauriège P, et al. Hyperinsulinemia as an independent risk factor for ischemic heart disease.N Engl J Med. 1996; 334; 952–958. CrossRef
- Howard G, O’Leary DH, Zaccaro D, Haffner S, Rewers M. Insulin sensitivity and atherosclerosis.Circulation. 1996; 93: 1809–1817.
- Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentration in man.Diabetologia. 1985; 28: 412–419. CrossRef
- Bonora E, Kiechl S, Willeit J, et al. Prevalence of insulin resistance in metabolic disorders: the Bruneck Study.Diabetes. 1998; 47: 1643–1649. CrossRef
- American Diabetes Association. Clinical practice recommendations 2003.Diabetes Care. 2003; 26(suppl 1): S1-S156. CrossRef
- Global Initiative for Asthma (GINA).Asthma Management and Prevention. Bethesda, Md: National Heart, Lung, and Blood Institute; 2002. NIH Publication No. 96-3659A.
- British Thoracic Society. British guideline on the management of asthma.Thorax. 2003; 58(suppl 1): i1-i94. CrossRef
- National Heart, Lung, and Blood Institute/World Health Organization.NHLBI/WHO Workshop Report: Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease: Global Initiative for Chronic Obstructive Lung Disease (GOLD). Bethesda, Md: NHLBI; 2004 (update).
- Komshian H-Y, Carantoni M, Abbasi F, Reaven GM. Relationship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy nondiabetic volunteers.Diabetes Care. 2000; 23: 171–175. CrossRef
- American Thoracic Society. Standardization of spirometry, 1994. update.Am J Respir Crit Care Med. 1995; 152: 1107–1136.
- Lentner C.Geigy Scientific Tables. Basel, Switzerland: Ciba-Geigy Ltd; 1982: 178.
- Emoto M, Nishizawa Y, Maekawa K, et al. Homeostasis model assessment as a clinical index of insulin resistance in type 2 diabetic patients treated with sulfonylureas.Diabetes Care. 1999; 22: 818–822. CrossRef
- Harrison TW, Tattersfield AE. Plasma concentrations of fluticasone propionate and budesonide following inhalation from dry powder inhalers by healthy and asthmatic subjects.Thorax. 2003; 58: 258–260. CrossRef
- Neville A, Palmer JBD, Gaddie J, May CS, Palmer KNV. Metabolic effects of salbutamol: comparison of aerosol and intravenous administration.BMJ. 1977; 1: 413–414. CrossRef
- Pinkney J. Clinical research methods in diabetes (Chapter 35). In: Pickup J, Williams G, eds.Textbook of Diabetes. Boston, Mass: Blackwell Science; 1997.
- Rana JS, Mittleman MA, Sheikh J, Hu FB, Manson JE. Chronic obstructive pulmonary disease, asthma, and risk of type 2 diabetes in women.Diabetes Care. 2004; 27: 2478–2484. CrossRef
- Spranger J, Kroke A, Mohlig M, et al. Inflammatory cytokines and the risk to develop type 2 diabetes: results of the prospective population-based European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study.Diabetes. 2003; 52: 812–817. CrossRef
- Effects of inhaled budesonide on insulin sensitivity in nondiabetic patients with asthma and chronic obstructive pulmonary disease
Advances in Therapy
Volume 24, Issue 3 , pp 560-570
- Cover Date
- Print ISSN
- Online ISSN
- Springer Healthcare Communications
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- inhaled corticosteroid therapy
- insulin sensitivity
- Industry Sectors
- Author Affiliations
- 1. Department of Internal Medicine, Cerrahpasa School of Medicine Istanbul University, Istanbul, Turkey
- 2. Department of Internal Medicine Division of Lung Diseases, Cerrahpasa School of Medicine Istanbul University, Istanbul, Turkey
- 3. Department of Metabolism and Diabetes Department of Internal Medicine Division of Endocrinology, Cerrahpasa School of Medicine Istanbul University, Istanbul, Turkey
- 4. Central Research Laboratory, Cerrahpasa School of Medicine Istanbul University, Istanbul, Turkey
- 5. Public Health Department, Cerrahpasa School of Medicine Istanbul University, Istanbul, Turkey