The coincidence of diabetes mellitus and asthma, their probable causal relationships and therapeutic opportunities.

Marcin Kosmalski,Tadeusz Pietras,Monika Różycka-Kosmalska,Andrzej Witusik

doi:10.5603/arm.a2020.0168

Abstract

Both the epidemiological data and the everyday medical practice demonstrate the coincidence of various types of diabetes mellitus (DM) in patients with asthma. Specific correlations between the risk of DM in pregnancy, asthma and the consequences of these diseases to the mother and her baby are also explored. The discussion concerning, on the one hand, the impact of asthma-related inflammatory condition on the metabolism of carbohydrates, and, on the other, the presence of chronic hyperglycemia and inflammatory markers observed in patients with asthma, is still ongoing. In the case of asthma and type 1 diabetes mellitus (T1DM), a correlation with the dysfunction of the immune system and the genetic background has been suggested, and in the case of type 2 (T2DM), the vital role of obesity and insulin resistance (IR) to promote excessive proinflammatory immune response. The data indicate that both asthma and DM affect mutually their clinical presentations, including the prognostic values and therapeutic possibilities. The ongoing controversy concerning the effective and safe anti-asthma and hypoglycemizing therapy does not allow for a definitive therapeutic consensus in this group of patients, despite the suggested role of metformin and hyperglycemizing effects of glucocorticoids. Therefore, the objective of the presented paper is a review of the knowledge in the field of DM and asthma coincidence, their probable causal relationships and therapeutic opportunities.

Highlights

In daily medical practice, either pneumological or diabetological, we are dealing with patients with diabetes mellitus (DM) coexistent with asthma
Despite the availability of studies assessing the etiopathological relationship between DM and asthma, there is still an ongoing discussion concerning the impact of inflammatory markers associated with asthma on the metabolism of carbohydrates
In the GEIRD (Gene Environment Interactions in Respiratory Diseases) study conducted on patients aged 45-64 and 65-84 years, including individuals with T2DM, no significant differences as to the incidence of asthma were observed in the analyzed groups of patients with and without DM

Summary

Introduction

Either pneumological or diabetological, we are dealing with patients with diabetes mellitus (DM) coexistent with asthma. From the theoretical point of view, the possible etiological mechanisms of the coexistence of both diseases and the factors influencing their mutual course should be sought. The available data suggest a significant effect of the carbohydrate metabolism on the presence of inflammation in the patients’ organism. These concerns stem from the lack of a sufficient number of studies exploring the relationship between asthma and the development of DM.

Objectives

Findings

Conclusion