Nurhan KÖKSAL, Mehmet Akif BÜYÜKBEŞE, Ali ÇETİNKAYA, FATMA İNANÇ TOLUN

Astımlılarda inhaler kortikosteroid kullanımı glukoz tolerans bozukluğu yapıyor mu?

İnhaler kortikosteroidlerin (İK) sistemik yan etkileri oldukça nadirdir. Keza uzun süre sistemik kullanılan kortikosteroidlerin diyabetojenik etkileri olabileceği iyi bilinmektedir. Bu çalışmada, astımlılarda İK kullanımı ile diyabet eğilimi arasındaki ilişki, oral glukoz tolerans testi yapılarak araştırıldı. Çalışmaya İK kullanan astımlı hastalar (n=83) ile kontrol grubu (n=34) kabul edilen ve herhangi bilinen bir hastalığı olmayan olgular alındı. Astım grubu ile kontrol grubu cinsiyet ve VKİ bakımından benzerdi. Astım grubu ortalama astım tanı süresi 8.9±6.4 yıl, İK kullanma süresi 4.2±2.7 yıl ve kullanılan ortalama İK dozu 616.66±355.62 µgr/gün idi. İK kullanan astım grubu açlık kan şekeri (AKŞ) 92.96±6.82 mg/dl, kontrol grubunda 93.05±12.51 mg/dl ve 75 gr glukoz yüklemesinden 2 saat sonra alınan kan şekerleri, astım grubunda 110.21±32.17 mg/dl iken kontrol grubunda 109.08±28.41 mg/dl idi. Her iki grup değerleri arasındaki fark istatistiksel olarak anlamlı değildi (p(0.05). Astım grubunda İK kullanma süresi ve İK dozu ile AKŞ ve 2. saat glukoz değerleri arasında korelasyona bakıldığında; İK kullanma süresi (4.2±2.7) ile 2. saat glukoz (110.21±32.17) arasında istatistiksel olarak anlamlı fakat zayıf pozitif korelasyon saptandı (p=0.007, r=0.292). Sonuç olarak astımlılarda İK kullanımı ile OGTT arasında zayıf da olsa pozitif korelasyon varlığı, uzun dönemde glukoz intoleransı üzerine etkileri olabileceğini göstermektedir.

Anahtar Kelimeler:

Astım, Adrenal korteks hormonları, Glukoz tolerans testi, Nebülizerler ve vaporizerler

May inhaled corticosteroid use give rise to impaired glucose tolerance in bronchial asthma?

Systemic side effects of inhaler corticosteroids (IC) are quite rarely. It is also well known that systemic use of corticosteroids for a long period of time may have diabetogenic effects. In this study, the relationship between use of IC in patients with bronchial asthma and tendency of development of diabetes was investigated via oral glucose tolerance test. Eighty three patients with bronchial asthma and 34 healthy subjects without any known disease as a control group were enrolled the study. Asthma group and control group were similar according to gender, age and BMI. Mean period for the diagnosis of asthma was 8.9±6.4 years, for IC use was 4.2±2.7 years and mean daily dose of IC was 616.66±355.62 µgr. Fasting blood glucose (FBG) for asthma group who were on IC and for control group were 92.96±6.82 mg/dl and 93.05±12.51 mg/dl, respectively. Following 75 gr OGTT, glucose levels for asthma group and control group were 110.21±32.17 mg/dl and 109.08±28.41 mg/dl, respectively. FBG levels and 2-hour glucose levels separately in both groups were not statistically significant (p(0.05). In asthma group, correlations between duration of IC use and, FBG and 2-hour glucose levels, and also between dose of IC and FBG and 2-hour glucose levels were evaluated. Statistically significant but mild positive correlation was seen between duration of IC (4.2±2.7 year) use and 2-hour glucose levels (110.21±32.17 mg/dl) (p=0.007, r=0.292). In conclusion, in patients with asthma, mild positive correlation between IC use and 2-hour glucose levels was observed. Our findings may point out that IC use over a long period of time may lead glucose intolerance.

Keywords:

Asthma, Adrenal Cortex Hormones, Glucose Tolerance Test, Nebulizers and Vaporizers,

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