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Diabetes Care 27:2478-2484, 2004
© 2004 by the American Diabetes Association, Inc.

Metabolic Syndrome/Insulin Resistance Syndrome/Pre-Diabetes
Original Article

Chronic Obstructive Pulmonary Disease, Asthma, and Risk of Type 2 Diabetes in Women

Jamal S. Rana, MD1, Murray A. Mittleman, MD, DRPH1,2, Javed Sheikh, MD3, Frank B. Hu, MD, PHD4, JoAnn E. Manson, MD, DRPH2,5,6, Graham A. Colditz, MD, DRPH2,5, Frank E. Speizer, MD5, R. Graham Barr, MD, DRPH5,7 and Carlos A. Camargo, Jr, MD, DRPH2,5,8

1 Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachussetts
2 Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
3 Division of Allergy and Inflammation, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
4 Department of Nutrition, Harvard School of Public Health, Boston, Massachusetts
5 Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
6 Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
7 Division of General Medicine, Department of Medicine, Columbia-Presbyterian Medical Center, New York, New York
8 Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts

Address correspondence and reprint requests to Dr. Camargo, Channing Laboratory, 181 Longwood Ave., Boston, MA 02115. E-mail: ccamargo{at}partners.org

OBJECTIVE—Inflammation plays a key role in chronic obstructive pulmonary disease (COPD) and asthma. Increasing evidence points toward a role of inflammation in the pathogenesis of type 2 diabetes. We wanted to determine the relation of COPD and asthma with the development of type 2 diabetes.

RESEARCH DESIGN AND METHODS—The Nurses’ Health Study is a prospective cohort study. From 1988–1996, 103,614 female nurses were asked biennially about a physician diagnosis of emphysema, chronic bronchitis, asthma, and diabetes.

RESULTS—During 8 years of follow-up, we documented a total of 2,959 new cases of type 2 diabetes. The risk of type 2 diabetes was significantly higher for patients with COPD than those without (multivariate relative risk 1.8, 95% CI 1.1–2.8). By contrast, the risk of type 2 diabetes among asthmatic patients was not increased (1.0, 0.8–1.2). The asthma results remained nonsignificant even when we evaluated diabetes risk by duration of asthma exposure.

CONCLUSIONS—Our findings suggest that COPD may be a risk factor for developing type 2 diabetes. Differences in the inflammation and cytokine profile between COPD and asthma might explain why COPD, but not asthma, is associated with increased risk of type 2 diabetes.

Abbreviations: COPD, chronic obstructive pulmonary disease • CRP, C-reactive protein • IL, interleukin • Th1, type 1 helper • Th2, type 2 helper • TNF, tumor necrosis factor


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