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Insulin demand higher in children with type 1 diabetes plus asthma
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Children with concomitant type 1 diabetes and asthma are more likely to require a higher insulin dose, reach shorter adult height and have a higher BMI vs. patients with type 1 diabetes who do not have asthma, according to findings reports in Pediatric Diabetes.
In a prospective, observational cohort study of children in Germany and Austria, researchers also found that the prevalence of asthma in children with type 1 diabetes was lower compared with the general population (3.4% vs. 4.7%), a contrast to findings in studies conducted in the United States, where there is a higher prevalence of asthma in adolescents with type 1 diabetes compared with the general population (10.8% vs. 8.7%).
“Being overweight is a supposed risk factor for developing asthma,” Birgit Rami-Merhar, MD, PhD, MBA, of the department of pediatrics and adolescent medicine at Medical University of Vienna, and colleagues wrote. “We suggest that this could be an influencing factor, contributing to higher asthma prevalence also in young individuals with [type 1 diabetes] in the United States. Even more, it has been postulated that overweight/obesity is an inflammatory or at least pro-inflammatory condition and this inflammation could promote existing asthma,
although this hypothesis is still controversial.”
Rami-Merhar and colleagues analyzed data from 51,926 children with type 1 diabetes from the German/Austrian DPV database through September 2011. Researchers analyzed electronic patient records for concomitant asthma diagnosis and for specific asthma medications; asthma was assumed if one or both were present for a patient. Researchers also assessed HbA1c, type of insulin therapy (convention, intensive therapy or pump therapy), severe hypoglycemia incidence, BMI and BMI z scores.
Within the cohort, 1,755 (3.4%) had both asthma and type 1 diabetes. Patients with both conditions were more likely to be boys (61% vs. 52%), were older and had a longer diabetes duration, and were more often using insulin pump therapy vs. a conventional insulin regimen, according to researchers.
Patients with asthma needed higher insulin doses (mean, 0.88 U/kg vs. 0.84 U/kg; P < .01), had a lower height standard deviation score (mean, –0.002 vs. 0.085; P < .01) and a higher BMI standard deviation score (mean, 0.31 vs. 0.028; P = .04).
There were no between-group differences for HbA1c, but patients with type 1 diabetes and asthma experienced more severe hypoglycemia vs. patients without asthma (45 vs. 3.2 events per 100 patient-years; P < .01).
“This higher insulin demand might be due to additional physical stress, less physical activity and, thereby, slightly higher insulin resistance, induced by asthma-associated inflammation, and/or concomitant drugs, first of all corticosteroids,” the researchers wrote.
Sixty-two percent of patients with asthma were on specific medications: 28% (n = 495 patients) were prescribed inhaled corticosteroids and 24% (n = 425) were prescribed sympathomimetic drugs, 6% (n = 104) were prescribed leukotriene receptor antagonists and 4% (n = 72) used unspecified drugs. Researchers found that patients prescribed sympathomimetic drugs had a higher mean HbA1c (8.42%) vs. those prescribed inhaled corticosteroids (8.18%) and leukotriene receptor antagonists (7.97%). – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.
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