Type 2 Diabetes Mellitus and Asthma: Pathomechanisms of Their Association and Clinical Implications

Abstract

Type 2 diabetes mellitus (T2DM) and asthma are chronic illnesses concomitantly present in a significant percentage of the population. Their comorbidity is associated with poor disease control and lower quality of life, thus imposing a substantial medical and economic burden worldwide. This review investigates the association between asthma and T2DM, in terms of pathogenesis, clinical outcomes, and therapeutic opportunities. Our review found an increased risk of asthma among diabetics, and vice versa. Having diabetes and poor glycemic control is associated with an increased rate of asthma exacerbations and increased mortality among those hospitalized for asthma exacerbations. The mechanisms postulated for the diabetes-asthma association include chronic low-grade inflammation, obesity, hyperinsulinemia, and possibly diabetic pneumopathy. Usage of metformin, which is the first-line drug for type 2 diabetes, was found to be associated with a decreased asthma occurrence, asthma exacerbations, and asthma-related hospitalizations. Glucagon-like peptide 1 receptor agonists were also found to be associated with a lower occurrence of asthma exacerbations. Thiazolidinediones are also associated with lower rates of asthma exacerbations, but their clinical efficacy for the same was suggested to be limited. This literature review supports a partly causative association between asthma and diabetes. This comorbidity leads to poor patient compliance, worse disease outcomes, and poor quality of life. Thus, further studies are warranted to explore the prognostic implications, therapeutic opportunities, and specific clinical practice algorithms for patients with concurrent asthma and type 2 diabetes mellitus.

Keywords: asthma; asthma exacerbation; diabetes; diabetes mellitus type 2; glycemic control.

Figure 1. Multi-organ effect of diabetes on the body

AGE: advanced glycation end-products, RAGE: receptor for advanced glycation end-products, IL: interleukin, TNF-α: tumor necrosis factor α, TGF-β: transforming growth factor, ROS: reactive oxygen species, ECM: extra-cellular matrix Image credits: Created by authors on BioRender software (BioRender, Toronto)

Figure 2. Factors responsible for the association between asthma and type 2 diabetes mellitus

Image credits: Created by authors on BioRender software