The absolute risk of incident type 2 diabetes following exposure to systemic corticosteroids in selected steroid‐related and phenotypic groups

Aims Exposure to corticosteroids is known to increase the risk of developing type 2 diabetes. We estimated the risk of incident type 2 diabetes in selected patient groups exposed to systemic corticosteroids. Materials and methods In a retrospective, observational cohort study, using real‐world data from UK primary care, patients were selected who had at least one episode of exposure to oral or intravenous corticosteroids for any indication. Corticosteroid‐exposed patients were matched with non‐exposed patients. Relative dosage was estimated as a weight‐based, prednisolone‐equivalent dose. Crude rates of progression to type 2 diabetes were determined for patient groups defined by relevant steroid‐related and phenotypic characteristics present at corticosteroid exposure. Results Overall, rates of incidence of type 2 diabetes were 12.5 and 6.7 events per thousand person‐years' (pkpy) exposure, respectively, in those who received at least one dose of corticosteroids versus those never exposed. This represented a rate ratio of 1.85 (95% CI 1.74‐1.97). The incidence of type 2 diabetes was found to be associated with several of the selected characteristics, both individually and multi‐dimensionally. The highest rate of incident type 2 diabetes was observed in very severely obese men aged 46‐55 years having had the longest corticosteroid exposure and highest corticosteroid dose (190 incident events pkpy exposure). Conclusions Corticosteroid exposure increased the risk of incident type 2 diabetes, and there was evidence of both a dose‐response and a duration response. The impact of corticosteroid exposure upon the rate of incident type 2 diabetes appeared, however, to involve a complex, multi‐dimensional interaction between the selected characteristics, some of which might be impacted by reverse causality.