Association Between Insulin Resistance and Disease Severity in Patients with Chronic Obstructive Pulmonary Disease: A Cross-Sectional Study

Abstract

Chronic obstructive pulmonary disease is a chronic inflammatory disorder accompanied by abnormalities including insulin resistance. Evidence suggests insulin resistance may contribute to progression, but its relationship with severity remains unclear in Southeast Asian populations. Study investigated associations with severity, pulmonary function, symptom burden, and exacerbation risk. In 77 chronic obstructive pulmonary disease patients, insulin resistance was assessed using the Homeostatic Model Assessment for Insulin Resistance. Severity included GOLD grades, Group ABE classification, pulmonary function, Modified Medical Research Council scale, COPD Assessment Test, and exacerbation history. Associations used Fisher–Freeman–Halton exact, Kruskal–Wallis, and Spearman's rank correlation tests. High or very high insulin resistance (HOMA-IR ≥3.0) was identified in 45.5% of participants. Higher HOMA-IR categories were significantly associated with advanced GOLD spirometry grades, Group ABE classification, and exacerbation risk (all p<0.001). HOMA-IR was negatively correlated with predicted FEV₁ (ρ = −0.634) and FEV₁/FVC (ρ = −0.602), while positive correlations were observed with mMRC score (ρ = 0.728), CAT score (ρ = 0.680), and exacerbation frequency (ρ = 0.702) (all p<0.001). Fasting insulin concentrations and HOMA-IR increased progressively across GOLD spirometry grades, accompanied by a smaller but statistically significant increase in fasting plasma glucose (p<0.001). Insulin resistance is associated with greater disease severity, obstructive pulmonary, increased symptom burden, and higher exacerbation risk in chronic obstructive pulmonary disease, supporting HOMA-IR as a biomarker of disease severity.​