Published online: March 8, 2019
Asthma in obese individuals has been consistently found to be more severe and difficult to treat. Pre-diabetes and diabetes are common disorders of blood sugar regulation that affect up to 100 million adults in the United States. Individuals with these conditions are also more likely to have other metabolic disorders, such as high cholesterol or high blood pressure. Research has suggested that these types of metabolic conditions may be especially relevant in obese patients with asthma, but the relationship between pre-diabetes or diabetes and asthma exacerbations has not been well-studied in this population.
In a research article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Wu and colleagues from Johns Hopkins University examined the association of pre-diabetes and diabetes with rates of asthma exacerbation in an insurance claims research database of working-age adults in the United States. The study included 5,722 obese individuals with asthma who had their hemoglobin A1c measured—a laboratory test that reflects average blood sugar over the past three months and is used to diagnose pre-diabetes and diabetes—and were followed for up to one year.
Compared to obese individuals with normal blood sugar, those with pre-diabetes and diabetes had a 27% and 33% higher rate of asthma exacerbation, respectively. These differences were not accounted for by differences in heartburn and sleep apnea, common conditions that have also been suggested as making asthma worse in obese patients.
These results highlight the important role of metabolic dysfunction in obese individuals with asthma and establish the hemoglobin A1c, a common laboratory test of pre-diabetes and diabetes, as a clinically relevant marker of asthma exacerbation risk.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.