Does Trelegy (fluticasone furoate) increase blood glucose levels?

Does Trelegy Increase Blood Glucose?

Yes, Trelegy (containing fluticasone furoate) can increase blood glucose levels, and this effect should be considered in patients with diabetes or risk factors for diabetes mellitus. 1

Mechanism and Evidence

The FDA label for fluticasone furoate (a component of Trelegy) specifically warns about potential hyperglycemic effects. According to the drug label, "There have been reports of increases in blood glucose levels with fluticasone furoate/vilanterol ELLIPTA. This should be considered in patients with a history of, or with risk factors for, diabetes mellitus." 1

This effect is primarily attributed to the corticosteroid component (fluticasone furoate) in Trelegy. Corticosteroids, even when inhaled, can have systemic effects including:

• Increasing blood glucose through gluconeogenesis
• Reducing insulin sensitivity
• Potentially worsening glycemic control in patients with pre-existing diabetes

Risk Factors and Monitoring

Patients at higher risk for hyperglycemia when using Trelegy include:

• Those with pre-existing diabetes mellitus
• Patients with impaired glucose tolerance
• Individuals with a family history of diabetes
• Elderly patients
• Those on higher doses of the medication

Clinical Recommendations

For patients starting or using Trelegy:

1. Baseline assessment: Consider checking blood glucose before initiating therapy, especially in high-risk patients.

2. Monitoring schedule:

   • For patients with diabetes: More frequent blood glucose monitoring may be needed after starting Trelegy
   • For patients without diabetes but with risk factors: Consider periodic glucose screening

3. Patient education: Inform patients about potential symptoms of hyperglycemia (increased thirst, frequent urination, fatigue, blurred vision) that should prompt medical attention.

4. Medication adjustment: In patients who develop significant hyperglycemia, consider:

   • Adjusting diabetes medications if applicable
   • Evaluating the risk-benefit ratio of continuing Trelegy
   • Possibly switching to alternative respiratory medications with less impact on glucose metabolism

Clinical Perspective

While hyperglycemia is a documented potential side effect of Trelegy, it's important to note that:

• The effect is generally modest in most patients
• The clinical significance varies based on individual risk factors
• The benefits of appropriate respiratory disease management often outweigh this risk
• Transient hyperglycemia has been reported even in pediatric patients using inhaled fluticasone propionate 2

For patients with diabetes who require triple therapy for COPD, more vigilant blood glucose monitoring is warranted, particularly in the first few months after initiating Trelegy therapy.