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Asthma and type 1 diabetes in children and adolescents

Diabetes Care for Children & Young People – March newsletter

An observational study into the impact of asthma and its treatment on young people with type 1 diabetes produces some interesting findings.

An investigation into the impact of asthma and its pharmacological treatment in young patients with type 1 diabetes has found that young patients with both conditions require higher insulin doses, although there is no major influence on metabolic control overall.
 
Findings on the prevalence of asthma and type 1 diabetes in children and adolescents have been conflicting. To establish the prevalence of concomitant asthma in young people with type 1 diabetes in Germany and Austria, and its influence on their metabolic control, investigators conducted a prospective observational cohort study.
 
Data from 51,926 individuals under 20 years on the German/Austrian DPC registry was searched to identify those with the diagnoses of both conditions and the asthma medication they used. 1755 (3.4%) of the cohort fulfilled the inclusion requirements.
 
After adjustment for variables, individuals with both conditions were found to require slightly higher insulin doses than those with only type 1 diabetes (0.88 vs 0.84 units/kg; P<0.01). The former group were more often males (61% vs 52%), were older and had longer duration of diabetes.
 
They also had a lower height standard deviation score (SDS; −0.002 vs 0.085; P<0.01), higher BMI-SDS (0.31 vs 0.28; P=0.04) and experienced more severe hypoglycaemia (4.5 vs 3.2 events/100 patient years; P<0.01).
 
There was no overall difference between the two groups in metabolic control assessed by HbA1c, although measurements in the sympathomimetic treatment sub-group were significantly higher than those using inhaled corticosteroids or leukotriene modifiers. The authors suggest that the increased insulin dose in those with asthma might be due to slightly higher insulin resistance, induced by inflammation and/or corticosteroid use.
 
In contrast to a previous US study, an almost equal prevalence of asthma in children and adolescents with type 1 diabetes compared to the general population was observed.
 
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