Association of Oral Hypoglycemic Medications With Reduced Radiological Severity in Diabetic Chronic Rhinosinusitis Patients

Introduction: The link between diabetes mellitus (DM) and asthma has been established with studies showing that DM medical treatment is associated with significantly lower asthma severity. Given the overlap between asthma and chronic rhinosinusitis (CRS) airway inflammation, our study aimed to examine the effect of DM medications on CRS.

Methods: We conducted a retrospective study on adults diagnosed with CRS at a single academic institution between 2020-2022. We compared incidence of asthma, nasal polyps (NP), and allergic rhinitis (AR) in CRS patients with or without DM. We assessed the impact of DM medications on the frequency of functional endoscopic sinus surgeries within the study period and CRS radiologic severity using Lund-Mackay (LM) scores in patients with CRS and DM, considering those on DM medication versus not.

Results: Our cohort consisted of 1,162 CRS patients, with 207 patients with DM (17.81%) and 955 (82.19%) without. There was no significant difference in asthma, NP, or AR for all CRS patients. There were significantly lower median LM scores in CRS patients with DM on metformin (4 vs 5, p= 0.048) or sulfonylureas (2 vs 5, p= 0.033) than those not taking those medications. Among CRS patients with NP and DM, those taking metformin and dipeptidyl peptidase-4 inhibitors demonstrated lower median LM scores of 7 versus 14 (p= 0.028) and 6 versus 13 (p= 0.026), respectively compared to those not taking those medications. In CRS without NP patients with DM, those taking sulfonylureas had lower median LM scores (2 versus 3, p= 0.045) than patients not taking sulfonylureas. There was no significant difference in undergoing functional endoscopic sinus surgery or having NP in any of the individual DM medications.

Conclusions: Our study is the first to demonstrate that CRS patients with DM treated with oral hypoglycemics have lower radiologic severity as assessed using LM scores. Future research should explore this association using CRS disease-specific quality of life instruments and conduct long-term follow up to evaluate its impact on sinonasal exacerbations and the need for revision surgeries.