Диабет усугубляет течение бронхоэктазов и повышает смертность пациентов

Patients with bronchiectasis and diabetes have more severe disease and worse long-term outcomes compared with those without diabetes, according to study findings published in The Lancet Respiratory Medicine. Investigators assessed outcomes and the microbial and inflammatory profiles of patients with bronchiectasis, with and without diabetes. Data were obtained from the European Bronchiectasis Registry (EMBARC), Respiratory Research Network of India (EMBARC-India), Chinese Bronchiectasis Registry (BE-China), and Australian Bronchiectasis Registry (ABR). All participants were adults with computed tomography–confirmed bronchiectasis as well as clinical symptoms consistent with bronchiectasis. Long-term exacerbations and those that resulted in hospital admission were assessed, and Cox proportional hazards regression was used to evaluate all-cause mortality. [P]atients with bronchiectasis and diabetes are a high-risk group, presenting with more severe disease, an increased prevalence of comorbidities, and worse long-term outcomes. The analysis included 30,263 patients with bronchiectasis from 33 countries; 2487 (8.2%) had diabetes and 27,776 (91.8%) were without diabetes. The patients with diabetes vs those without were more likely to be older and male and to have a history of smoking and an increased body mass index (all P <.0001). A majority of participants were White (51.0%). An increase in comorbidities was found among patients with diabetes vs without, with the largest increase occurring for cardiovascular disorders (53.5% vs 21.8%, P <.0001). An increased prevalence of comorbid respiratory diseases also was observed in patients with diabetes vs without, including asthma (27.5% vs 21.0%, P <.0001) and chronic obstructive pulmonary disease (COPD; 34.3% vs 19.0%, P <.0001). Patients with diabetes had an increased Bronchiectasis Severity Index score vs those without diabetes (8 vs 7, P <.0001), as well as increased frequency of hospital admission in the previous year (P <.0001). Participants with diabetes were significantly more likely to have had at least 3 exacerbations within the past year vs those without diabetes (27.6% vs 23.4%, P <.0001). Long-term outcomes were assessed in 11,153 patients in EMBARC and EMBARC-India. Individuals with diabetes vs those without had more frequent exacerbations (incidence rate ratio [IRR], 1.18; 95% CI, 1.09-1.28; P <.0001) and higher hospital admission rates (IRR, 1.57; 95% CI, 1.40-1.76; P <.0001). The patients with diabetes had a higher all-cause 5-year mortality vs those without diabetes (hazard ratio, 1.80; 95% CI, 1.53-2.12; P <.0001). The inflammatory markers Gal-4 and GDF-15 were significantly increased in patients with bronchiectasis and diabetes, including after adjustment (Gal-4, P <.0001; GDF-15, P =.0019). In microbiology results from 1298 patients with diabetes and 15,597 without diabetes who had an available sputum sample, a significant increase was found in the rate of isolation of the following pathogens in patients with diabetes vs those without: Enterobacteriaceae (12.6% vs 9.0%, P <.0001), Moraxella catarrhalis (3.4% vs 2.1%, P =.003), and Haemophilus influenzae (12.9% vs 11.0%, P =.046). Limitations include the observational design and missing data. In addition, short-term antibiotic use, GLP-1 receptor agonist use, and duration of comorbidities were not recorded in the registries, and the cause of death was not available. “This study conclusively shows that patients with bronchiectasis and diabetes are a high-risk group, presenting with more severe disease, an increased prevalence of comorbidities, and worse long-term outcomes than patients without diabetes, independent of geographical region,” the investigators stated. Disclosure: Some of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. This article originally appeared on Pulmonology Advisor References: Hull RC, Liu Y, Cao Z, et al; on behalf of EMBARC, EMBARC India, Australian bronchiectasis registry and BE-China. Comorbid diabetes disease severity and microbial changes in patients with bronchiectasis: a combined analysis of data from the EMBARC, EMBARC-India, Australian, and BE-China registries. Lancet Respir Med. Published online May 19, 2026. doi:10.1016/S2213-2600(26)00057-3