Asthmatic kids with type 1 diabetes have tougher time maintaining healthy sugar levels: Study

By Dr. Ananya Mandal, MDSep 27 2011

According to anew study children with both asthma and type 1 diabetes have an especially tough time keeping their blood sugar under control.

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. The study appears in the October issue of Pediatrics.

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 Association. 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.

The new study led by Mary Helen Black of Kaiser Permanente Southern California revealed that 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. 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.

Dr. Juan Celedon, chief of service, division of pediatric pulmonology, allergy and immunology at Children's Hospital of Pittsburgh disagreed, “I don't think there's any biology behind this association.” Instead, he said, “the ones taking these medications are the ones with better insurance and access to quality health care.” He added, “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.”

On the other hand, Black said, it may simply be tougher for kids with type 1 diabetes to control their blood sugar when they have another chronic health problem. “It can be incredibly challenging to manage both conditions,” Black said. She said the bottom line for doctors and parents is to be aware that kids with diabetes may have a somewhat higher rate of asthma - and that those with both may have more trouble with blood sugar control.