Chronic Airflow

Chronic obstructive pulmonary disease (COPD) is characterized by a chronic airflow obstruction that is associated with severe global mortality and morbidity. A team of researchers from USA, led by Chaitanya Mamillapalli, at the Endocrinology department at the Springfield Clinic in Illinois have publish a review on the relationship between COPD and T2 DM in Current Respiratory Medicine Reviews.
Type 2 diabetes (T2 DM) is a metabolic disease associate with hyperglycemia; so insulin resistance; also relative insulin deficiency. The global prevalence of T2 DM has increase dramatically in the last two decades; so with an estimate 382 million people diagnose in 2013 and the incidence is rapidly growing. It is project to affect 592 million people by 2035. COPD is increasingly being recognize; hence as a systemic inflammatory condition affecting more than just the lung.

Personalize therapeutic intervention

Comorbid chronic health conditions associate with COPD have poorer outcomes; so require complex personalize therapeutic intervention approach. COPD is being increasingly recognize as a risk factor for the development of T2 DM through different mechanisms including systemic inflammation; so obesity, hypoxia and use of corticosteroids. Hyperglycemia in diabetes patients is also link to the adverse impact on lung physiology; so a possible increase in the risk of COPD.

T2 DM and COPD are both expect to be among the top ten leading causes of mortality and burden of disease worldwide by 2030. There are limit clinical studies addressing the management of patients who have T2 DM and COPD. Presently, management options are gear towards symptomatic management but do not address the underlying cause of these diseases.

It would be ideal to target treatments to address the underlying systemic inflammation; but no such therapeutic agents are available yet. The standard of care respiratory management with timely treatment of COPD exacerbations; also flu vaccination, antibiotic use can result in the reduction of oxidative stress and systemic inflammation, which will, in turn, will reduce insulin resistance and optimize glucose control in T2 DM patients.

Crucial in patients

Achieving optimal glucose control is crucial in patients with coexistent T2 DM and COPD; hence to prevent adverse outcomes in COPD patients and diabetic complications relate to T2 DM. The researchers also review the safety and outcome data for various diabetes treatment agents such as metformin, thiazolidinediones, Glucagon like peptide -1 analogues and insulin use in COPD patients.

Given the overwhelming evidence of the association between the COPD and T2 DM; so their intertwine pathologies and the impact on the prognosis, it is important for the endocrinologist to measure lung function in T2 DM patients and for pulmonologists to screen for T2 DM in COPD patients.

The team of researchers believes that this collaborative partnership is crucial for improving the outcomes in patients. The team also agrees additional research is require to improve our knowledge about the relationship between COPD and T2 DM, to help with providing better care with these two common disorders.