Skip to main content

Advertisement

Log in

Type 1 diabetes and asthma: a systematic review and meta-analysis of observational studies

  • Meta- Analysis
  • Published:
Endocrine Aims and scope Submit manuscript

Abstract

Purpose

Type 1 diabetes (T1D) and asthma are both the top concurrent non-communicable diseases in the world, and the existence of a relationship between the two is an area of debate.

Methods

All eligible observational studies in PubMed and EMBASE databases from inception to August 2021 were searched for data extraction and analysis. The pooled odds ratio (OR) with corresponding 95% confidence intervals (95% CI) was evaluated using fixed-effects or random-effects models in RevMan 5.3, and I2 and Cochran Q tests were used to assess the heterogeneity.

Results

22 studies with 25,578 T1D and 3,330,901 non-T1D were included in this meta‐analysis. After data analysis, there seems to be no apparent connectivity between asthma and T1D as the crude OR (cOR) was 1.07 (95%CI, 0.93–1.23). Nevertheless, after limiting the meta-analysis to 6 studies with adjusted OR (aOR) available, the results suggested a positive association between T1D and asthma (aOR, 1.15; 95%CI, 1.06–1.25). Corresponding with this, a meta-analysis of cohort studies also found a positive association between T1D and asthma with the pooled cOR of 1.27 (95% CI, 1.09–1.49) and aOR of 1.15 (95%CI, 1.05–1.26). Further analysis of 7 studies in which the diagnosis of asthma precedes T1D onset revealed that asthma patients are at increased risk of subsequent T1D with the pooled cOR of 1.23 (95%CI, 1.04–1.44) and aOR of 1.58 (95% CI, 1.11–2.24).

Conclusion

Our meta-analysis suggests a possible association between T1D and asthma, and patients who were previously diagnosed with asthma carried higher odds of developing T1D.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this article and its supplementary material files. Further enquiries can be directed to the corresponding author.

References

  1. M.A. Atkinson, G.S. Eisenbarth, A.W. Michels, Type 1 diabetes. Lancet 383, 69–82 (2014)

    Article  PubMed  Google Scholar 

  2. Q. Ni, N.B. Pham, W.S. Meng et al. Advances in immunotherapy of type I diabetes. Adv. Drug Deliv. Rev. 139, 83–91 (2019)

    Article  CAS  PubMed  Google Scholar 

  3. J.A. Bluestone, J.H. Buckner, K.C. Herold, Immunotherapy: building a bridge to a cure for type 1 diabetes. Science 373, 510–516 (2021)

    Article  CAS  PubMed  Google Scholar 

  4. F. Pociot, Å. Lernmark, Genetic risk factors for type 1 diabetes. Lancet 387, 2331–2339 (2016)

    Article  CAS  PubMed  Google Scholar 

  5. Y. Xia, Z. Xie, G. Huang et al. Incidence and trend of type 1 diabetes and the underlying environmental determinants. Diabetes Metab. Res Rev. 35, e3075 (2019)

    Article  PubMed  Google Scholar 

  6. J.W. Mims, Asthma: definitions and pathophysiology. Int Forum Allergy Rhinol. 5, S2–S6 (2015)

    Article  PubMed  Google Scholar 

  7. S.C. Dharmage, J.L. Perret, A. Custovic, Epidemiology of asthma in children and adults. Front Pediatr. 7, 246 (2019)

    Article  PubMed  PubMed Central  Google Scholar 

  8. J. Kero, M. Gissler, E. Hemminki et al. Could TH1 and TH2 diseases coexist? Evaluation of asthma incidence in children with coeliac disease, type 1 diabetes, or rheumatoid arthritis: a register study. J. Allergy Clin. Immunol. 108, 781–783 (2001)

    Article  CAS  PubMed  Google Scholar 

  9. T.R. Mosmann, R.L. Coffman, TH1 and TH2 cells: different patterns of lymphokine secretion lead to different functional properties. Annu Rev. Immunol. 7, 145–173 (1989)

    Article  CAS  PubMed  Google Scholar 

  10. The EURODIAB Substudy 2 Study Group, Decreased prevalence of atopic diseases in children with diabetes. J. Pediatr. 137, 470–474 (2000)

    Article  Google Scholar 

  11. P.S. Mattila, J. Tarkkanen, H. Saxen et al. Predisposition to atopic symptoms to inhaled antigens may protect from childhood type 1 diabetes. Diabetes Care 25, 865–868 (2002)

    Article  PubMed  Google Scholar 

  12. L.G. Strömberg, G.J. Ludvigsson, B. Björkstén, Atopic allergy and delayed hypersensitivity in children with diabetes. J. Allergy Clin. Immunol. 96, 188–192 (1995)

    Article  PubMed  Google Scholar 

  13. C. Duran, D. Ediger, C. Ersoy et al. Frequency of atopy and allergic disorders among adults with Type 1 diabetes mellitus in the southern Marmara region of Turkey. J. Endocrinol. Invest 31, 211–215 (2008)

    Article  CAS  PubMed  Google Scholar 

  14. A.I. Smew, C. Lundholm, L. Sävendahl et al. Familial coaggregation of asthma and type 1 diabetes in children. JAMA Netw. Open 3, e200834 (2020)

    Article  PubMed  PubMed Central  Google Scholar 

  15. D. Moher, A. Liberati, J. Tetzlaff et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6, e1000097 (2009)

    PubMed  PubMed Central  Google Scholar 

  16. J. Siemiatycki, E. Colle, S. Campbell et al. Case-control study of IDDM. Diabetes Care 12, 209–216 (1989)

    Article  CAS  PubMed  Google Scholar 

  17. A.B. Olesen, S. Juul, N. Birkebaek et al. Association between atopic dermatitis and insulin-dependent diabetes mellitus: a case-control study. Lancet 357, 1749–1752 (2001)

    Article  CAS  PubMed  Google Scholar 

  18. S.W. Huang, J. Hitchcock, Influence of the TH1/TH2 paradigm: the prevalence of asthma and allergic diseases in patients with type 1 diabetes in the United States. Pediatr. Asthma Allergy Immunol. 15, 195–199 (2002)

    Article  Google Scholar 

  19. J. Rosenbauer, P. Herzig, G. Giani, Atopic eczema in early childhood could be protective against Type 1 diabetes. Diabetologia 46, 784–788 (2003)

    Article  CAS  PubMed  Google Scholar 

  20. C. Caffarelli, G. Cavagni, R. Pierdomenico et al. Coexistence of IgE-mediated allergy and type 1 diabetes in childhood. Int Arch. Allergy Immunol. 134, 288–294 (2004)

    Article  CAS  PubMed  Google Scholar 

  21. L.C. Stene, G. Joner, Atopic disorders and risk of childhood-onset type 1 diabetes in individuals. Clin. Exp. Allergy 34, 201–206 (2004)

    Article  CAS  PubMed  Google Scholar 

  22. C.R. Cardwell, D.J. Carson, J. Yarnell et al. Atopy, home environment and the risk of childhood-onset type 1 diabetes: a population-based case-control study. Pediatr. Diabetes 9, 191–196 (2008)

    Article  PubMed  Google Scholar 

  23. M. Cakir, S. Akcay, T. Karakas et al. Prevalence of atopy in children with type 1 diabetes mellitus, hepatitis B virus carriers, and healthy children: role of T helper 1 (Th1)-type immune response. Allergy Asthma Proc. 29, 166–170 (2008)

    Article  CAS  PubMed  Google Scholar 

  24. K. Karavanaki, E. Tsoka, C. Karayianni et al. Prevalence of allergic symptoms among children with diabetes mellitus type 1 of different socioeconomic status. Pediatr. Diabetes 9, 407–416 (2008)

    Article  PubMed  Google Scholar 

  25. M.A. Tosca, E. Villa, M. Silvestri et al. Discrepancy between sensitization to inhaled allergens and respiratory symptoms in pediatric patients with type 1 diabetes mellitus. Pediatr. Allergy Immunol. 20, 385–391 (2009)

    Article  PubMed  Google Scholar 

  26. S.F. Thomsen, D.L. Duffy, K.O. Kyvik et al. Relationship between type 1 diabetes and atopic diseases in a twin population. Allergy 66, 645–647 (2011)

    Article  CAS  PubMed  Google Scholar 

  27. Y.T. Hsiao, W.C. Cheng, W.C. Liao et al. Type 1 diabetes and increased risk of subsequent asthma: a nationwide population-based cohort study. Medicine 94, e1466 (2015)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. S. Klamt, M. Vogel, T.M. Kapellen et al. Association between IgE-mediated allergies and diabetes mellitus type 1 in children and adolescents. Pediatr. Diabetes 16, 493–503 (2015)

    Article  CAS  PubMed  Google Scholar 

  29. J. Metsälä, A. Lundqvist, L.J. Virta et al. The association between asthma and type 1 diabetes: a paediatric case-cohort study in Finland, years 1981-2009. Int J. Epidemiol. 47, 409–416 (2018)

    Article  PubMed  Google Scholar 

  30. J. Metsälä, A. Lundqvist, L.J. Virta et al. Use of antiasthmatic drugs and the risk of type 1 diabetes in children: a nationwide case-cohort study. Am. J. Epidemiol. 189, 779–787 (2020)

    Article  PubMed  Google Scholar 

  31. A. Lamminsalo, A. Lundqvist, L.J. Virta et al. Cow’s milk allergy in infancy and later development of type 1 diabetes-nationwide case-cohort study. Pediatr. Diabetes 22, 400–406 (2021)

    Article  CAS  PubMed  Google Scholar 

  32. K. Hirahara, T. Nakayama, CD4+ T-cell subsets in inflammatory diseases: beyond the Th1/Th2 paradigm. Int Immunol. 28, 163–171 (2016)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. I.F. Douek, N.J. Leech, H.A. Gillmor et al. Children with type-1 diabetes and their unaffected siblings have fewer symptoms of asthma. Lancet 353, 1850 (1999)

    Article  CAS  PubMed  Google Scholar 

  34. N. Krug, J. Madden, A.E. Redington et al. T-cell cytokine profile evaluated at the single cell level in BAL and blood in allergic asthma. Am. J. Respir. Cell Mol. Biol. 14, 319–326 (1996)

    Article  CAS  PubMed  Google Scholar 

  35. S.T. Azar, H. Tamim, H.N. Beyhum et al. Type I (insulin-dependent) diabetes is a Th1-and Th2-mediated autoimmune disease. Clin. Diagn. Lab Immunol. 6, 306–310 (1999)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. L.M. Araujo, J. Lefort, M.A. Nahori et al. Exacerbated Th2-mediated airway inflammation and hyperresponsiveness in autoimmune diabetes-prone NOD mice: a critical role for CD1d-dependent NKT cells. Eur. J. Immunol. 34, 327–335 (2004)

    Article  CAS  PubMed  Google Scholar 

  37. R.L. Rabin, A.I. Levinson, The nexus between atopic disease and autoimmunity: a review of the epidemiological and mechanistic literature. Clin. Exp. Immunol. 153, 19–30 (2008)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. M. Bjørnvold, M.C. Munthe-Kaas, T. Egeland et al. A TLR2 polymorphism is associated with type 1 diabetes and allergic asthma. Genes Immun. 10, 181–187 (2009)

    Article  PubMed  CAS  Google Scholar 

  39. M.F. Moffatt, I.G. Gut, F. Demenais et al. A large-scale, consortium-based genomewide association study of asthma. N. Engl. J. Med. 363, 1211–1221 (2010)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. J.C. Barrett, D.G. Clayton, P. Concannon et al. Genome-wide association study and meta-analysis find that over 40 loci affect risk of type 1 diabetes. Nat. Genet 41, 703–707 (2009)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. A. Tedeschi, L. Airaghi, Common risk factors in type 1 diabetes and asthma. Lancet 357, 1622 (2001)

    Article  CAS  PubMed  Google Scholar 

  42. A. Tedeschi, L. Airaghi, Is affluence a risk factor for bronchial asthma and type 1 diabetes? Pediatr. Allergy Immunol. 17, 533–537 (2006)

    Article  PubMed  Google Scholar 

Download references

Funding

This work was funded by the National Natural Science Foundation of China (81770029).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Liang Dong.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Ethics

This systematic review and meta-analysis followed the guidelines of the PRISMA statement.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zeng, R., Wang, Z., Zhang, J. et al. Type 1 diabetes and asthma: a systematic review and meta-analysis of observational studies. Endocrine 75, 709–717 (2022). https://doi.org/10.1007/s12020-021-02973-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12020-021-02973-x

Keywords

Navigation