Chen Chiung-Zuei, Hsu Chih-Hui, Li Chung-Yi, Hsiue Tzuen-Ren
a Division of Chest Medicine, Department of Internal Medicine , National Cheng Kung University Medical College and Hospital , Tainan , Taiwan.
b Institute of Public Health, National Cheng Kung University Medical College , Tainan , Taiwan.
J Asthma. 2017 Dec;54(10):1019-1025. doi: 10.1080/02770903.2017.1283698. Epub 2017 Jan 31.
Recent reports have suggested that insulin promotes airway smooth muscle contraction and enhances airway hyperresponsiveness, which are cardinal features of asthma. In contrast, metformin can reduce both airway inflammatory and remodeling properties. However, these results are all from in vitro and animal studies. This study investigated whether diabetes and various antidiabetic agents associate with the risk of asthma.
We used a retrospective population-based cohort study using Taiwan's National Health Insurance claim database from 2000 to 2010 and a Cox proportional hazards regression model to compare the incidence of asthma between patients with diabetes (n = 19,428) and a matched non-diabetic group (n = 38,856). We also used a case-control study nested from the above cohort including 1,982 incident cases of asthma and 1,982 age- and sex-matched controls. A time density sampling technique was used to assess the effects of various antidiabetic agents on the risk of asthma.
The incidence of asthma was significantly higher in the diabetic cohort than that in the non-diabetic cohort after adjustment for age, sex, and obesity, with a hazard ratio of 1.30 (95% confidence interval [CI]: 1.24-1.38). Insulin was found to increase the risk of asthma among diabetic patients (odds ratio [OR] 2.23; 95% CI: 1.52-3.58). In contrast, the use of metformin correlated with a decreased risk of asthma (OR 0.75; 95% CI: 0.60-0.95).
Individuals with diabetes are at an increased risk of asthma. Insulin may further increase the risk of asthma, but the risk could possibly be reduced by using metformin.
近期报告表明，胰岛素可促进气道平滑肌收缩并增强气道高反应性，而这正是哮喘的主要特征。相比之下，二甲双胍可降低气道炎症和重塑特性。然而，这些结果均来自体外和动物研究。本研究调查了糖尿病及各种抗糖尿病药物与哮喘风险之间的关联。
我们采用基于人群的回顾性队列研究，使用2000年至2010年台湾国民健康保险理赔数据库，并运用Cox比例风险回归模型比较糖尿病患者（n = 19,428）和匹配的非糖尿病组（n = 38,856）之间哮喘的发病率。我们还采用了从上述队列中嵌套的病例对照研究，包括1982例哮喘新发病例和1982例年龄及性别匹配的对照。采用时间密度抽样技术评估各种抗糖尿病药物对哮喘风险的影响。
在调整年龄、性别和肥胖因素后，糖尿病队列中哮喘的发病率显著高于非糖尿病队列，风险比为1.30（95%置信区间[CI]：1.24 - 1.38）。发现胰岛素会增加糖尿病患者患哮喘的风险（优势比[OR] 2.23；95% CI：1.52 - 3.58）。相比之下，使用二甲双胍与哮喘风险降低相关（OR 0.75；95% CI：0.60 - 0.95）。
糖尿病患者患哮喘的风险增加。胰岛素可能会进一步增加哮喘风险，但使用二甲双胍可能会降低该风险。
