Pharmacological interactions between asthma and T2DM therapies: clinical and metabolic implications

Asthma and type 2 diabetes mellitus (T2DM) frequently coexist and share overlapping immunometabolic pathways. Pharmacotherapies used to treat either condition may influence the course of the other, leading to clinically relevant cross-effects.

This narrative review synthesizes evidence on the bidirectional pharmacologic interactions between asthma and T2DM therapies, focusing on the metabolic consequences of asthma medications and the pulmonary effects of glucose-lowering agents. We highlight mechanistic links, comparative clinical impacts, and phenotype-specific considerations.

Systemic corticosteroids and, to a lesser extent, high-dose inhaled corticosteroids, increase the risk of insulin resistance and hyperglycemia. β₂-agonists may acutely raise glucose levels, whereas leukotriene antagonists and LAMAs have minimal metabolic impact. Biologics indirectly benefit metabolic control by allowing steroid reduction, with dupilumab showing the most favorable profile. Among antidiabetic agents, metformin and GLP-1 receptor agonists robustly improve asthma outcomes, and SGLT2 inhibitors show promising signals. Insulin may worsen airway hyperresponsiveness through proliferative and immunologic pathways. Clinicians must navigate these interactions thoughtfully, especially in type 2-low and obesity-associated asthma, where metabolic dysfunction dominates disease expression. Evidence-based guidance remains lacking, underscoring the need for integrated, phenotype-driven approaches.