Asthma Can Complicate Diabetes Care in Kids09/26/11
MONDAY, Sept. 26 (HealthDay News) -- Children hit with the
double whammy of type 1 diabetes and asthma have an especially
tough time keeping their blood sugar under control, a new study
The reason why asthma might complicate pediatric diabetes care
remains unclear, however, and is "something that needs to be
explored more," said Dr. Anita Swamy, a pediatric endocrinologist
and medical director of the Chicago Children's Diabetes Center at
La Rabida Children's Hospital in Chicago.
She was not involved in the new study, which appears in the
October issue of
About 215,000 children in the United States have diabetes,
according to the U.S. Centers for Disease Control and Prevention.
Most children who have diabetes have type 1 diabetes, although type
2 diabetes is becoming more prevalent in kids. Type 1 diabetes is
an autoimmune disease that causes the body to mistakenly attack the
insulin-producing cells in the pancreas. Insulin is a hormone that
helps the body process carbohydrates in food. Type 2 diabetes
occurs when the body doesn't produce enough insulin, or when it
stops using insulin effectively, according to the American Diabetes
Asthma is a chronic disease that causes inflammation in the
airways, and when someone with asthma is exposed to a trigger, the
disease causes the muscles in the lungs to tighten, making
breathing very difficult. About 7 million American children have
asthma, the CDC reports.
According to the new study, which was led by Mary Helen Black of
Kaiser Permanente Southern California, about 11 percent of children
with diabetes also struggle with asthma. Her team theorized that
the inflammation that's present with untreated asthma might make it
harder to control blood sugar levels.
The study tracked almost 1,700 children diagnosed with type 1
diabetes and 311 diagnosed with type 2 diabetes between 2002 and
2005, and found that 10 percent of those children with type 1
diabetes and just over 16 percent of those with type 2 diabetes
also had asthma.
In kids with type 1 diabetes, the average hemoglobin A1C levels
were about 7.5 for children without asthma and 7.8 for those with
asthma. A1C is a test that measures long-term blood sugar control.
The higher the number, the higher the average blood sugar was.
Non-diabetic people generally have an A1C below 6.
Overall, kids with type 1 diabetes and asthma were 37 percent
more likely to have poor glycemic [blood sugar] control than to
have good control, compared to children without the respiratory
ailment. "Among youth with type 1 diabetes, asthma is associated
with poor glycemic control, especially if asthma is untreated," the
study authors concluded.
However, they did not find a statistically significant link
between type 2 diabetes and asthma control. That might be because
they had fewer children in the study with both of those conditions,
the team suggested.
The use of asthma medications significantly impacted blood sugar
control, reported the researchers. Seventy-two percent of children
with type 1 diabetes and asthma who were treated with leukotriene
modifiers (brand names are Accolate, Singulair, Zyflo) achieved
good blood sugar control, according to the study. Leukotriene
modifiers are preventive medications that need to be taken every
day. They're not available in generic forms.
Still, one expert was skeptical of a true physiological link
between asthma and blood sugar control.
"I don't think there's any biology behind this association," said Dr. Juan Celedon, chief of service, division of pediatric pulmonology, allergy and immunology at Children's Hospital of Pittsburgh. Instead, he said, "the ones taking these medications are the ones with better insurance and access to quality health care."
And, that's Celedon's issue with the study as a whole. "My
concern is that there is confounding by socioeconomic status and
access to health care. They needed to adjust the data for more
things. When they adjusted for race and ethnicity, the associations
went down. And, children with untreated asthma and poor glycemic
control may be the kids who aren't getting adequate health care,"
Swamy agreed, adding, "this is one of those studies that finds
an association, but it's hard to know if it's causal. We don't know
why they're linked."
In the meantime, she also pointed out that some asthma
medications can raise blood sugar levels, which could affect blood
sugar control if parents and children aren't aware of that
Corticosteroids, especially oral steroids, can raise blood sugar
levels, though Swamy said recent research has noted a link between
inhaled corticosteroids and higher blood sugar levels. Certain
asthma rescue medications -- inhaled medications known as
beta-agonists -- can also raise blood sugar levels, according to
"I tell primary care doctors to let us [endocrinologists] know when a child with asthma and diabetes needs a change in medications. If I know, I can preemptively change the insulin regimen and blood sugar control can still be good. The same goes for when a child has an asthma flare," said Swamy.
She added that parents shouldn't hesitate to call their child's
diabetes health care team to find out what changes, if any, need to
be made to their child's insulin regimen to account for asthma
Learn more about asthma medications from the
American Academy of Allergy, Asthma and
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