Kosmalski Marcin, Różycka-Kosmalska Monika, Witusik Andrzej, Pietras Tadeusz
Department of Clinical Pharmacology, Medical University of Lodz, Lodz, Poland.
Department of Electrocardiology, Medical University of Lodz, Lodz, Poland.
Adv Respir Med. 2020;88(6):590-598. doi: 10.5603/ARM.a2020.0168.
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.
流行病学数据和日常医疗实践均表明，哮喘患者中存在各种类型的糖尿病（DM）。本文还探讨了妊娠糖尿病风险、哮喘以及这些疾病对母亲和婴儿的影响之间的具体关联。一方面，关于哮喘相关炎症状态对碳水化合物代谢的影响，另一方面，哮喘患者中观察到的慢性高血糖和炎症标志物的存在，相关讨论仍在进行中。在哮喘与1型糖尿病（T1DM）的病例中，已有人提出其与免疫系统功能障碍和遗传背景有关；而在2型糖尿病（T2DM）的病例中，肥胖和胰岛素抵抗（IR）在促进过度促炎免疫反应中起着至关重要的作用。数据表明，哮喘和糖尿病会相互影响其临床表现，包括预后价值和治疗可能性。尽管有人提出二甲双胍的作用以及糖皮质激素的降糖作用，但关于有效且安全的抗哮喘和降糖治疗的持续争议，使得在这组患者中无法达成明确的治疗共识。因此，本文的目的是综述糖尿病与哮喘并存领域的知识、它们可能的因果关系以及治疗机会。
