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

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.