November 19, 2024 – A groundbreaking study published in JAMA Internal Medicine reveals that commonly used diabetes medications, specifically metformin and glucagon-like peptide-1 receptor agonists (GLP-1RAs), can significantly reduce the frequency of asthma attacks. The research indicates that these medications can lower asthma attack rates by as much as 70%, independent of a patient’s weight or blood sugar control.
Conducted by researchers in England, the cohort study found that metformin is associated with a 30% reduction in asthma attacks, while GLP-1RAs contribute an additional 40% reduction. This discovery suggests a promising new direction for asthma treatment, particularly for patients with type 2 diabetes (T2D), who often experience increased asthma attack risks and rely heavily on corticosteroids that can adversely affect metabolic health.
The relationship between asthma, obesity, and T2D is well-documented, with T2D exacerbating asthma symptoms and increasing the need for corticosteroid treatment. Metformin, recognized as the first-line treatment for T2D, is not only safe and affordable but also exhibits potential anti-inflammatory properties that may protect lung function. It is believed to work through mechanisms such as activating adenosine monophosphate-activated protein kinase and downregulating insulin-like growth factor 1, both of which can help reduce airway inflammation.
While previous studies have hinted at metformin’s ability to decrease asthma attacks, many lacked controls for critical factors like smoking and glycemic status. Additionally, the specific effects of GLP-1RAs on lung function and asthma severity have not been thoroughly investigated. This study aimed to fill that gap by examining the impact of metformin on asthma attacks while also considering the effects of add-on diabetes medications.
The research utilized data from the United Kingdom Clinical Practice Research Datalink Aurum database, which includes a broad sample of over two million adults. The study focused on 2,021,469 participants aged 17 and older diagnosed with asthma, specifically those with at least two asthma-related codes within two years. Individuals with type 1 diabetes, chronic obstructive pulmonary disease, or chronic kidney disease were excluded from the analysis.
To enhance the reliability of the findings, a triangulation approach was employed. This included a self-controlled case series (SCCS) design, which accounted for constant confounders like genetics and socioeconomic status, and an inverse probability of treatment weighting (IPTW) cohort to address potential biases in treatment assignment.
The primary outcome measured was the rate of asthma attacks over a 12-month period, defined by the use of oral corticosteroids, emergency visits, hospitalizations, or death. The study also controlled for various covariates, including age, sex, body mass index (BMI), glycemic control, asthma severity, and smoking history.
Among the participants, 81.5% had recorded BMI data, with 53.9% classified as overweight or obese and 6.9% diagnosed with T2D. The study found that metformin users experienced a significant reduction in asthma attacks (P < .001), with effects observable within three months and lasting for up to a year. In the IPTW cohort, those on metformin had a 24% lower risk of experiencing asthma attacks.
Sensitivity analyses supported these findings, and Kaplan-Meier plots indicated a lower incidence of asthma attacks among metformin users. Notably, no associations were found between metformin use and unrelated health outcomes, further validating the specificity of the results. Among the add-on antidiabetic drugs, only GLP-1RAs demonstrated a sustained reduction in asthma attacks.
Importantly, the beneficial effects of metformin were consistent across different BMI categories, HbA1c levels, eosinophil counts, asthma severity, and sex, suggesting that these factors do not influence its effectiveness.
Conclusion
The study concludes that metformin can reduce asthma attacks by 30%, with an additional 40% reduction when combined with GLP-1RAs. These findings underscore the potential for repurposing antidiabetic medications in asthma treatment. However, further research and clinical trials are necessary to confirm these effects and to better understand the underlying mechanisms involved. This research opens new pathways for improving asthma management in patients with diabetes, potentially transforming treatment strategies in the future.
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