A study on HbA1c profile in children with asthma using inhaled corticosteroids
Keywords:Bronchial asthma, HbA1c, Inhaled corticosteroids
Background: Inhaled corticosteroids (ICS) are the mainstay of treatment for persistent bronchial asthma in children. Even though ICS is comparatively safe, few systemic toxicities have been reported. We have conducted a study on HbA1c profile of 170 asthmatic children who are on ICS for atleast 6 months. Glycosylated hemoglobin (HbA1c), fasting blood sugar (FBS), Postprandial blood sugar (PPBS) levels were measured before initiating ICS and after 6 months using venous blood samples. HbA1c measured using immunoassay. The objective of the study was to detect prevalence of significant hyperglycemia among children with asthma who are on inhaled corticosteroids. Study design used as a prospective follow up study, setting of the study was to Pediatric asthma clinic, Govt. TDMCH, Alappuzha, Study population used Children between 3 to 12 years attending pediatric asthma clinic.
Methods: Cumulative doses of ICS and bronchodialators were measured by providing an asthma diary to mark the dose of medication. FBS, PPBS, and HbA1c levels were measured before initiating ICS and after 6 months. To elucidate the assosiations comparisons between different parameters Chi-square test was used as non-parametric test. Student’s T- test was used to compare mean values between 2 groups and different groups. Initial and follow up two groups of HbA1c and ICS administrations were compared using paired and unpaired T-test.
Results: There is a significant increase in the mean HbA1c of the total study population before and after treatment with ICS.
Conclusions: Long term use of ICS can affect glucose metabolism of asthmatic children.
Liu AH, Covar RA, Spahn JD, Donald YM. Leung Nelson Text Book of Pediatrics, 18th edition, Volume-1 part 1-XVI chapter-143 Childhood Asthma page: 953-970.
Saaddine JB, Fagot A, Rollka DK, Narayan KMV. Distribution of HbA1c levels for children and young adults in the US 3rd National Health and Nutrition Examination Survey. Diab Care. 2002;25(8):1326-30.
Selvin E, Steffes MW, Zhu H, Matsushita K, Wagenknecht L, Pankow J, Coresh J, Brancati FL. Glycated HB, Diabetes and Cardiovascular risk in non-diabetic adults New England J Medic. 2010;362:800-11.
Yucel O, Eker Y, Nuhoglu C, Ceran O. HbA1c levels in children with asthma using low dose inhaled corticosteroids. Indian Pedia. 2009;46:300-3.
Sathiyapriya V, Bobby Z, Kumar SV, Selvaraj N, Parthibane V, Gupta S. Evidence for the role of lipid peroxides on glycation of hemoglobin and plasma proteins in non-diabetic asthma patients. Clin Chim Acta. 2006;366:299-303.
Kiviranta K, Turpeinen M. Effect of eight months of inhaled beclomethasone dipropionate and budesonide on carbohydrate metabolism in adults with asthnma. Thorax. 1993;48:974-8.
Turpeinen M, Sorva R, Juntunen, Backman K. Changes in carbohydrate and lipid metabolism in children with asthma inhaling budesonide.J Allergy Clin Immunol. 1991;88:384-9.
Goldstein DE, Konig P. Effect of inhaled beclomethasone dipropionate on hypothalamic- pituitary-adrenal axis function in children with asthma.Pediatrics. 1983;72:60-4.
National asthma education and prevention program. Expert panel report 2: guidelines for the diagnosis and management of asthma update on selected topics 2002. J Allergy Clin Immunol. 2002:110:141-219.
Donnelly R, Seale JP. Clinical pharmacokinitics of inhaled budesonide. Clin Pharmacokinet. 2001;40:427-40.
Harrison TW. Systemic availability of inhaled budenoside and fluticasone propionate: healthy versus asthmatic lungs. Bio drugs. 2001;15:405-11.
Brustche MH, Brutsche IC, Munawar M, Langley SJ, Masterson CM, Daleyates PT. Comparison of pharmacokinetics and systemic effects of inhaled fluticasone propionate in patients with asthma and healthy volunteers: a randomized crossover study. 2000;356:556-61.