{"doi":"10.1001/jamainternmed.2024.5983","title":"Borrowing From the Type 2 Diabetes Armamentarium for Asthma","abstract":"Asthma is the most prevalent chronic respiratory disease across the lifespan.Obesity, insulin resistance, hyperglycemia, and their end result, overt type 2 diabetes, are associated with increased asthma prevalence and morbidity 1 .Several large observational studies suggest that metformin and glucagon-like peptide-1 receptor agonists (GLP-1RAs) may reduce asthma exacerbations, symptoms, and hospitalizations [2][3][4] .Yet no study has specifically looked at the additive impact of these medications on asthma outcomes and few studies have adequately controlled for glycemic control, asthma severity and inflammatory phenotype.In the study 'Association of antidiabetic medication and asthma attacks: self-controlled case series and population-based cohort', Lee et al. report that metformin use was associated with a 24% reduction in asthma exacerbation risk and add-on therapy with GLP-1RAs, but not other diabetes medications, was associated with a ~ 40% further reduction in exacerbation risk in a nationally representative, primary care electronic health records database (the United Kingdom's Clinical Practice Research Datalink, CPRD) 5 .Using two orthogonal statistical methods, their approach addressed limitations of prior studies, included a diabetic diet \"control\" as a comparison to metformin use, and multiple negative control analyses to evaluate for bias.Metabolic parameters [body mass index (BMI), baseline %HbA1c, or change in %HbA1c], asthma severity, blood eosinophil counts as a biomarker of inflammatory phenotype, and sex did not modify the observed benefits of metformin and GLP-1RAs on asthma outcomes.These data suggest that clinical asthma response to metformin and/or GLP-1RAs in individuals with type 2 diabetes is independent of the conventional eosinophilic \"type 2 (T2) inflammation\" asthma phenotype dichotomization (high vs low) that predicts clinical response to our currently available therapeutics including biologics.In this regard, Lee et al's analyses go beyond supporting preferential use of these medications in patients with comorbid type 2 diabetes and asthma, raising the question: Should metformin and GLP-1RAs be considered for asthma therapy without T2D?Exploring novel approaches to asthma treatment, especially for patients with type 2 diabetes or obesity, is driven by current treatment limitations.Glucocorticoids, in inhaled form for maintenance and reliever therapy and systemic form for the treatment of acute exacerbations, remain the blunt cornerstone of asthma management.Yet, the risks","journal":"JAMA Internal Medicine","year":2024,"id":479161,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9559,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":263305,"name":"Dinah Foer","orcid":"0000-0002-0717-5714","position":1,"is_corresponding":false},{"id":263307,"name":"Katherine N. Cahill","orcid":"0000-0002-8549-1835","position":0,"is_corresponding":true}],"reference_count":8,"raw_metadata":null,"created_at":"2026-07-19T02:06:50.355747Z","pmid":"39556391","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}