Short Corticosteroid Courses Linked to Serious Events in Type 2 Diabetes

Short courses of oral corticosteroids were associated with higher rates of gastrointestinal bleeding, pneumonia, and heart failure among adults with type 2 diabetes in a Taiwan study published in JAMA Network Open.

Investigators used national insurance data from 2008 through 2022 in a cohort study with a self-controlled case series design. The analysis included 36,048 adults with type 2 diabetes who received an oral corticosteroid burst, defined as continuous treatment for 14 days or less. Mean age was 61.6 years, and 52.4% were women. The researchers compared event rates after burst initiation with rates during a baseline period within the same patients. They assessed gastrointestinal bleeding, pneumonia, sepsis, heart failure, and fracture.

During days 6 through 30 after treatment began, gastrointestinal bleeding was more frequent than during baseline (incidence rate ratio [IRR], 1.71; 95% CI, 1.52–1.94), as were pneumonia (IRR, 2.06; 95% CI, 1.65–2.57) and heart failure (IRR, 1.87; 95% CI, 1.27–2.77). These associations remained significant after adjustment for multiple comparisons.

During days 31 through 90, higher rates persisted for gastrointestinal bleeding (IRR, 1.26; 95% CI, 1.14–1.38), and fracture rates were higher (IRR, 1.42; 95% CI, 1.21–1.68). Sepsis was assessed but was not among the outcomes reported as significantly elevated during days 6 through 30 or 31 through 90 after adjustment for multiple comparisons. A negative control outcome, syncope, was not associated with corticosteroid bursts, and the principal findings held across sensitivity analyses.

The authors noted that insurance data could not establish whether patients took the prescribed medication or account for lifestyle factors. Residual confounding and outcome misclassification were also possible, and they cautioned against assuming the results apply to other ethnic populations. The investigators concluded that the findings support careful risk-benefit assessment when prescribing oral corticosteroid bursts in this population; the observational design limits causal conclusions.

Source: Yao TC, Hsu CC, Sheu WH, et al. Oral corticosteroid bursts and risk of serious adverse events in adults with type 2 diabetes. JAMA Netw Open. 2026;9(9):e2635604. doi:10.1001/jamanetworkopen.2026.35604