Author Identifier (ORCID)
Abstract
Aims: To investigate the association and dose–response between systemic and topical glucocorticoids and odds of Type 2 diabetes mellitus. Materials and Methods: We conducted a nationwide case–control study using Danish registry data from 2013 to 2021. People aged 40 years or older with incident type 2 diabetes mellitus (n = 149 113) were matched 1:3 with controls (n = 447 339) by age, sex and weighted Charlson Comorbidity Index. Glucocorticoid exposure was defined as ≥ 1 prescription within 1 year before the date of diagnosis and ≥ 2 within 3 years and classified as systemic or topical. Conditional logistic regression estimated ORs with 95% CIs, and dose–response associations were assessed according to daily prednisolone-equivalent dose. Results: Incident Type 2 diabetes mellitus cases had higher glucocorticoid exposure and cumulative doses than controls among oral systemic and dermatologic glucocorticoids. Odds increased progressively with higher doses of oral systemic glucocorticoids: adjusted OR 1.25 (95% CI, 1.21–1.29) at < 2.5 mg/day; 1.49 (95% CI, 1.43–1.56) at 2.5–7.4 mg/day; and 3.02 (95% CI, 2.90–3.15) at ≥ 7.5 mg/day. Dermatologic glucocorticoids showed a similar gradient, from 1.21 (95% CI, 1.18–1.23) at < 2.5 mg/day to 1.51 (95% CI, 1.40–1.63) at ≥ 7.5 mg/day. No progressively significant associations were observed for nasal, rectal, ophthalmic or otic formulations after adjustment. Conclusion: Systemic and dermatologic glucocorticoid use was associated with a clear dose-dependent increase in Type 2 diabetes mellitus odds, including at doses < 2.5 mg/day. Other topical routes appeared metabolically safe. Consideration of cumulative glucocorticoid exposure should inform prescribing and monitoring practices.
Keywords
glucocorticoids, prevention, type 2 diabetes mellitus
Document Type
Journal Article
Date of Publication
1-1-2026
ISSN
14628902
Publication Title
Diabetes, Obesity and Metabolism
Publisher
Wiley
School
Nutrition and Health Innovation Research Institute
Funding Information
This work was supported by the National Heart Foundation of Australia Future Leader Fellowship (107323) and Danish Diabetes and Endocrine Academy (NNF22SA0079901).
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License
Recommended Citation
Vadsholt, D., Kvist, A. V., Sandiramoorthy, C., Lewis, J. R., Vestergaard, P., Røikjer, J., & Rasmussen, N. H. (2026). Dose–response association between systemic and dermatologic glucocorticoid use and type 2 diabetes mellitus: A nationwide case–control study. Diabetes, Obesity and Metabolism. Advance online publication. https://doi.org/10.1111/dom.71001