Type 1 Diabetes and Increased Risk of Subsequent Asthma

Abstract

The association between type 1 diabetes mellitus (T1DM) and asthma remains controversial and has led to new interest in these 2 disorders. The purpose of this study was to examine the associations among young people with T1DM and asthma and offer a clinical demonstration of the balance between Th1 and Th2 responses.We conducted a retrospective cohort study by using data from the National Health Insurance (NHI) system of Taiwan. The cohort consisted of 3545 T1DM cases and 14,180 controls established during the 1998 to 2011 period. Of the 3545 T1DM patients, 55.1% were girls and 26.5% were in the age group <8 years.The overall incidence of asthma was 47% higher in the T1DM cohort than in the control cohort (6.49 vs 4.42 per 1000 person-y), with an adjusted hazard ratio (HR) of 1.34 (95% confidence interval [CI] = 1.11–1.62). Moreover, T1DM patients who visited the emergency room (ER) more than twice for diabetes had a higher adjusted HR of 17.4 (95% CI = 12.9–23.6) of developing asthma. The adjusted HR of asthma was 38.6 (95% CI = 28.5–52.2) in T1DM patients who had been hospitalized more than twice for diabetes.We observed a significantly higher incidence of asthma in young patients with T1DM than in the general population. Among young people of T1DM with more ER visits or frequent hospitalization because of diabetes mellitus were associated with risk of asthma, may indicate that poor glycemic control significantly contributes to asthma risk.

Reduced mortality from lower respiratory tract disease in adult diabetic patients treated with metformin

“…T1D and T2D have different pathogeneses and might affect CLRD outcomes distinctly or through different mechanisms. Some studies have reported a negative association between T1D and asthma, while others have reported increased risk of asthma and asthma exacerbations among subjects with T1D …”

Regulation of contact sensitivity in non‐obese diabetic (NOD) mice by innate immunity

“…NOD mice are mainly used for type 1 diabetes (T1D) studies; however, the NOD genetic background predisposes to other autoimmune disorders, such as arthritis, sialitis, and thyroiditis . Human studies have shown that T1D patients have an increased incidence of allergy . However, little is known about how autoimmune genetic factors affect allergy.…”

“…12 Human studies have shown that T1D patients have an increased incidence of allergy. 13,14 However, little is known about how autoimmune genetic factors affect allergy. To investigate the interaction of autoimmune genetic factors with innate immunity in the CHS response, we studied CHS immune responses by using NOD mice deficient in innate immunity.…”

Diabetes and Lung Disease: A Neglected Relationship

“…In one study, it was shown that asthma symptoms preceded the diagnosis of diabetes by a few years, regardless of glucocorticoid treatment [24]. Likewise, uncontrolled diabetes has been associated with a higher risk of asthma, and poor glycemic control has been related to increased asthma risk [25]. In contrast, a large prospective study found no significant statistical relationship among women with asthma [26], suggesting that the diabetes-asthma association is still not sufficiently well established.…”

“…It has been shown that diabetes is a pro-inflammatory state associated with airway inflammation [34]. Studies on type 2 diabetes have shown that it causes airway hyperresponsiveness in human airway smooth muscle cells in vitro [35], in diabetic animal models [36], and in humans [25]. Therefore, the most investigated pathway in the pathogenesis of the diabetes-asthma association is chronic inflammation such as RAGE.…”