Diabetes Could Increase Risk of Chronic Rhinosinusitis With Nasal Polyps

This article was originally published on AJMC.com.

New research suggests patients with diabetes mellitus (DM) may be at greater risk of developing chronic rhinosinusitis (CRS) with nasal polyps (CRSwNP) and subsequent olfactory dysfunction.

CRS affects 5% to 10% of people worldwide and has been linked with severe sinonasal symptoms, as well as substantial social and economic burden. Notably, CRS is categorized into 2 phenotypes, CRSwNP and CRS without nasal polyps (CRSsNP), in which the increased T helper (Th) 2 and Th17 cells found in those with nasal polyps are considered to provoke respiratory diseases.

“There is clinical evidence of an association between DM and respiratory tract infections; however, a causal relationship has not been established,” noted researchers. “Patients with DM are known to be generally more vulnerable to infections, and DM may increase the inflammatory characteristics of sinonasal disease.”

In order to determine the association between DM and CRS phenotypes, they conducted a retrospective cross-sectional study of population-based data derived from the Korean National Health and Nutrition Survey between January 2008 and December 2012 (n=34,670).

Participants aged over 19 years were examined on the relationship of CRS prevalence, with and without nasal polyps, with physician-diagnosed DM and non-DM. Additionally, differences in sinonasal symptoms between patients with and without DM were analyzed.

In the analysis, there were 2608 (mean [SD] age, 60.71 [0.33]) patients in the DM group and 29,262 (mean [SD] age, 43.95 [0.17]) patients in the non-DM group. Prevalence of CRSwNP was indicated to be significantly higher in the DM group vs non-DM group (3.90% vs 2.57%; OR, 1.538; 95% CI, 1.136-2.082; P = .005), whereas no significant difference in CRSsNP prevalence was found between the DM group and non-DM group (3.30% vs 3.70%; OR, 0.887; 95% CI, 0.649-1.212; P=.452).

After adjusting for potential confounding factors, multiple logistic regression analyses showed a significant association between DM and CRSwNP across 3 models, with no significant association found between DM and CRSsNP in any of the assessed models:

• Model 1: adjusted for sex, smoking, and heavy drinking
• Model 2: adjusted for sex, smoking, heavy drinking, family income, and residence
• Model 3: adjusted for sex, smoking, heavy drinking, family income, residence, stroke, hypertension, bronchial asthma, dyslipidemia, and pulmonary tuberculosis
  Moreover, olfactory dysfunction persisting for greater than 3 months was indicated to be significantly more frequent in the DM vs non-DM group (OR, 1.796; 95% CI, 1.082-2.982; P=.023).

Researchers concluded that further investigation is warranted to determine the direct mechanism of the association between DM and CRSwNP to clarify the pathogenesis of CRSwNP.

This study, "Association between diabetes mellitus and chronic rhinosinusitis with nasal polyps: A population-based cross-sectional study," was published in Clinical Otolaryngology.