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Children with Both Asthma and Type 1 Diabetes Face Greater Difficulties Controlling Blood Sugar

A recent study has found that it can be very difficult for children who suffer from both type 1 diabetes and asthma to regulate their blood sugar, though how asthma could complicate pediatric diabetes is still unclear.

Dr. Anita Swamy, a pediatric endocrinologist and medical director of the Chicago Children's Diabetes Center at La Rabida Children's Hospital in Chicago, reported that this connection between the two afflictions is "something that needs to be explored more.” Swamy was not a part of the study.

According to the CDC, roughly 215,000 children in the United States have diabetes. While these children predominantly suffer from type 1 diabetes, type 2 diabetes is increasing in frequency.

Conversely, almost 7 million children in the United States suffer from asthma.

In America, 11% of children with diabetes also suffer from asthma. Mary Helen Black, of Kaiser Permanente Southern California, and her colleagues sought to find out whether the inflammation present in children with untreated asthma could make it more difficult for them to control blood their sugar levels.

A1C is a test used to measure long-term blood sugar control. The higher the average blood sugar of the patient, the higher the number. People living without diabetes usually have an A1C below six.

The study, led by Black, followed roughly 1,700 children diagnosed with type 1 diabetes and 311 diagnosed with type 2 diabetes between the years of 2002 and 2005; they discovered that 10% of the children with type 1 diabetes and 16% of those with type 2 diabetes also had asthma.

They also found that the average hemoglobin A1C levels in kids with type 1 diabetes were about 7.5 for children without asthma and 7.8 for children with asthma.

Further, children with both type 1 diabetes and asthma were 37% more likely to have worse control over their blood sugar than children without asthma. "Among youth with type 1 diabetes, asthma is associated with poor glycemic control, especially if asthma is untreated," the study authors reported.

A statistically significant connection between asthma and type 2 diabetes, however, was not established, which could be a result of the fewer number of children in the study with both of these conditions, stated the authors.

Interestingly, the researchers reported that children who used asthma medications significantly increased their blood sugar control. According to the results of the research, 72% of children with type 1 diabetes and asthma taking leukotriene modifiers managed their blood sugar levels better. Leukotriene modifiers are preventive therapies that must be administered daily, but they are not available in generic forms.

Not everyone, however, is convinced of the validity of these results.

"I don't think there's any biology behind this association," stated Dr Juan Celedon, chief of service, division of pediatric pulmonology, allergy and immunology at Children's Hospital of Pittsburgh.

“The ones taking these medications are the ones with better insurance and access to quality health care,” he continued.  "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.”

Celedon concluded that “children with untreated asthma and poor glycemic control may be the kids who aren't getting adequate health care.”

This study will appear in the October issue of the journal Pediatrics.
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