Long-Term Risk of Type 2 Diabetes Associated With Topical Corticosteroid Use: A Nationwide Population-Based Cohort Study in Korea.

Abstract

Steroid-induced diabetes mellitus (SIDM) is a well-known side effect of corticosteroid agents. While diabetes induced by systemic corticosteroids has been extensively studied for over 60 years, evidence regarding the association between topical corticosteroids and Type 2 diabetes remains limited. This study aimed to investigate the relationship between topical corticosteroid use and the risk of Type 2 diabetes. A nationwide, population-based cohort study was conducted using data from the Korea National Health Insurance Service National Sample Cohort Database (NHIS-NSC2). A total of 186,057 adults without prior Type 2 diabetes were included in the cohort for follow-up. Among these, 14,944 adults who had been treated with topical corticosteroids and 171,113 adults with no history of topical corticosteroid use were included and followed prospectively for approximately 9 years. The primary outcome was the incidence of Type 2 diabetes following topical corticosteroid use, with additional analyses by frequency and potency of corticosteroid use. Kaplan-Meier curves and Cox proportional hazard models were used to estimate hazard ratios (HR) for Type 2 diabetes. The use of topical corticosteroids was significantly associated with an increased risk of Type 2 diabetes (adjusted HR [aHR] 1.13, 95% CI 1.06-1.20). The high-frequency corticosteroid group demonstrated the highest risk (aHR 1.27, 95% CI 1.09-1.48), while the moderate-potency corticosteroid group also showed a significant increase in risk (aHR 1.15, 95% CI 1.04-1.27). Notably, the diabetes risk in the moderate-potency group was comparable to that observed in the systemic corticosteroid group (aHR 1.20, 95% CI 1.14-1.26). In this study, the use of topical corticosteroids was significantly associated with the incidence of Type 2 diabetes. These findings highlight the importance of considering diabetes risk factors when prescribing topical corticosteroids.