Short steroid courses linked to higher risks of pneumonia and heart failure in adults with type 2 diabetes

by Sanjukta Mondal, Medical Xpress

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Allergy and asthma flare-ups often require short, high-dose courses of oral corticosteroids for immediate symptom relief. While these medications rapidly reduce inflammation, they can disrupt glucose homeostasis—the body's finely tuned system for keeping blood sugar levels within a narrow, healthy range so cells get the energy they need without letting glucose levels climb too high.

A recent study examined whether short bursts of oral steroids could raise the risk of serious complications in adults with type 2 diabetes. After analyzing data from 36,048 adults, the researchers found that even these brief courses were associated with a higher risk of gastrointestinal bleeding, pneumonia and heart failure in the following six to 30 days.

The effects of a brief steroid course lingered for weeks. Even 31 to 90 days after starting treatment, some risks remained elevated, including the risk of bone fractures, which was still 1.42 times higher than normal.

The findings are published in JAMA Network Open.

Side effects for people with diabetes

Corticosteroids are medications made from synthetic versions of cortisol, the hormone our adrenal glands release to trigger our body's stress response. Several studies and clinical observations have found that bursts of these medications can raise blood glucose by making the body more resistant to insulin and reducing how much insulin it produces and releases.

The effects can persist for different lengths of time depending on the steroid. With prednisolone, for example, blood sugar can climb within a few hours of a dose and then drop back down, while other corticosteroids, such as dexamethasone, can keep it elevated for much longer.

Medical guidelines already recommend that doctors watch for blood sugar spikes when prescribing oral corticosteroid bursts to people with diabetes. However, researchers do not yet know whether short steroid courses pose serious risks for people with type 2 diabetes beyond raised blood sugar. Adults with type 2 diabetes are already vulnerable to infections, cardiovascular problems and fractures, so it's crucial to understand how much extra risk a steroid course adds to that existing burden.

Trailing effects of a short course

To better measure the risks, the researchers analyzed health records from Taiwan's National Health Insurance Research Database covering 15 years. The team identified adults with type 2 diabetes who had received a short course of oral steroids, then ran a self-controlled case series in which each patient served as their own control. For each patient, they compared the risk of a medical emergency—stomach bleeding, pneumonia, sepsis, heart failure or bone fractures—in the weeks right after taking steroids with their baseline risk when they weren't taking them.

They found that during the first month after starting a steroid burst, patients experienced sharply elevated risks for three major health emergencies: double the risk of pneumonia, an 87% higher risk of heart failure and a 71% higher risk of stomach bleeding.

Although the risks decreased over time, they remained significant. Between one and three months after finishing the course of steroids, the risks of fracture and stomach bleeding remained 42% and 26% above baseline, respectively.

The findings don't suggest doctors should stop treating patients with oral corticosteroids, as they are essential medications. The researchers, however, say the numbers warrant carefully weighing risks and benefits when prescribing oral corticosteroid bursts to this high-risk population.

Further research in wider populations is needed to build robust guidelines that clinicians can follow when prescribing corticosteroids to people with diabetes.

Written for you by our author Sanjukta Mondal, edited by Sadie Harley, and fact-checked and reviewed by Robert Egan—this article is the result of careful human work. We rely on readers like you to keep independent science journalism alive. If this reporting matters to you, please consider a donation (especially monthly). You'll get an ad-free account as a thank-you.

Publication details

Tsung-Chieh Yao et al, Oral Corticosteroid Bursts and Risk of Serious Adverse Events in Adults With Type 2 Diabetes, JAMA Network Open (2026). DOI: 10.1001/jamanetworkopen.2026.35604

Journal information: JAMA Network Open

Key medical concepts

Diabetes Type 2Heart FailurePneumoniaGastrointestinal Bleeding

Clinical categories

EndocrinologyCommon illnesses & Prevention Who's behind this story?

Sanjukta Mondal

Master's in Chemistry. Freelance science journalist and communicator. Published in Chemistry World, BioSpace, and The Hindu. Full profile →

Sadie Harley

BSc Life Sciences & Ecology. Microbiology lab background with pharmaceutical news experience in oil, gas, and renewable industries. Full profile →

Robert Egan

Bachelor's in mathematical biology, Master's in creative writing. Well-traveled with unique perspectives on science and language. Full profile →

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Citation: Short steroid courses linked to higher risks of pneumonia and heart failure in adults with type 2 diabetes (2026, September 29) retrieved 29 September 2026 from https://medicalxpress.com/news/2026-09-short-steroid-courses-linked-higher.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.