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Do Topical Steroids Increase Diabetes Risk?

A recent systematic review and meta-analysis found a potential association between topical corticosteroid use and the risk of developing type 2 diabetes mellitus. The risk appeared to be dependent on cumulative dose and cumulative duration and not potency of the topical corticosteroid.

Topical corticosteroids are widely used in dermatology for a range of conditions, including atopic dermatitis and psoriasis. “Theoretically, prolonged topical steroid use raises the diabetogenic potential of topical steroids, however, this has not been well evaluated,” the researchers said.

They performed a systemic review and meta-analysis to investigate the potential association between topical corticosteroid use and development of diabetes. Studies that compared the proportion of patients with diabetes among those taking topical corticosteroids compared with those not taking topical corticosteroids were identified. The researchers calculated odds ratios (OR), which were used as a summary statistic, and calculated heterogeneity using I2 statistics.
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A total of 4 case-control studies were included in the meta-analysis. The researchers observed a significant association between topical corticosteroid use and development of type 2 diabetes mellitus, even after adjusting for confounding factors (OR, 1.24; 95% CI, 1.15-1.34, I2=91%, p<0.00001). However, they did not observe a potency-dependent effect nor any significant difference between subgroups.

For dermatologists, this poster abstract has significant implications, as short-term courses of potent and very potent topical followed by lower intensity maintenance therapy are used to manage inflammatory skin diseases.

“Prolonging the use of topical corticosteroids will lead to higher cumulative doses, regardless of steroid potency,” the researchers said. “Based on the current review findings, this would increase the risks of developing diabetes.”

Reference

Phan K, Smith SD. Topical corticosteroids and risk of diabetes mellitus: Systemic review and meta-analysis. Abstract presented at: 2020 American Academy of Dermatology Virtual Meeting Experience; June 12-14, 2020.

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