Section of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, Texas.
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Curr Opin Pulm Med. 2021 Jan;27(1):29-36. doi: 10.1097/MCP.0000000000000738.
Disorders of glucose metabolism, including insulin resistance, prediabetes, and diabetes, have been identified as risk factors for worsened asthma. This review summarizes emerging evidence for their role as modifiable risk factors in asthma, including the potential benefit of diabetes medications on asthma outcomes.
Experimental studies show that hyperinsulinemia associated with insulin resistance is associated with airway smooth muscle proliferation and promotes contractility. Epidemiologic studies have identified a higher prevalence of glycemic dysfunction among those with severe and uncontrolled asthma, and longitudinal studies have associated prediabetes and diabetes with higher risk of asthma exacerbations. The potential benefits of thiazolidinediones (TZDs), glucagon-like peptide-1 agonists, and metformin being investigated in asthma, but thus far interventional studies of TZDs have reported null results. On the contrary, observational studies have inconsistently controlled for relevant confounders which leaves conclusions vulnerable to misattribution of relationships due to corelated metabolic disorders, including dyslipidemia.
Developing evidence suggests that disorders of glucose metabolism may be associated with worsening asthma. However, these conditions arise within a network of obesity-related metabolic diseases that may themselves worsen asthma. Few interventional trials have not identified a benefit, but data have been limited. Additional research is needed to define the potential independent impact of disorders of glucose metabolism in asthma.
葡萄糖代谢紊乱，包括胰岛素抵抗、糖尿病前期和糖尿病，已被确定为哮喘恶化的危险因素。本综述总结了这些因素作为哮喘可改变危险因素的新证据，包括糖尿病药物对哮喘结局的潜在益处。
实验研究表明，与胰岛素抵抗相关的高胰岛素血症与气道平滑肌增殖有关，并促进了收缩性。流行病学研究表明，在严重和未控制的哮喘患者中，血糖功能障碍的发生率更高，纵向研究表明，糖尿病前期和糖尿病与哮喘恶化的风险更高有关。噻唑烷二酮类（TZDs）、胰高血糖素样肽-1 激动剂和二甲双胍在哮喘中的应用正在研究中，但迄今为止，TZDs 的干预研究报告结果为阴性。相反，观察性研究没有一致地控制相关的混杂因素，这使得由于相关代谢紊乱（包括血脂异常）而导致关系归因错误的结论变得脆弱。
不断发展的证据表明，葡萄糖代谢紊乱可能与哮喘恶化有关。然而，这些情况出现在与肥胖相关的代谢性疾病网络中，这些疾病本身可能会使哮喘恶化。很少有干预试验没有发现益处，但数据有限。需要进一步研究来确定葡萄糖代谢紊乱在哮喘中的潜在独立影响。
