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Association Between Pre-Diabetes/Diabetes and Asthma Exacerbations in a Claims-Based Obese Asthma Cohort.
BACKGROUND: Metabolic dysfunction may contribute to worsened asthma in obesity. The relationship between pre-diabetes and diabetes, metabolic conditions more common in obesity, and asthma outcomes is not well-characterized.
OBJECTIVE: We sought to determine the association between pre-diabetes/diabetes and asthma exacerbations in an obese asthma cohort.
METHODS: A retrospective cohort of US obese adults with asthma, age 18-64, was created from a claims-based health services database spanning 2010-2015. Individuals with a hemoglobin A1c (HbA1c) measurement were identified, categorized as within normal (<5.6%), pre-diabetes (5.7-6.4%), and diabetes (≥6.5%) ranges. Exacerbations, defined as asthma-related hospitalization, emergency department visit, or corticosteroid prescription ±14 days of an asthma-related outpatient visit, were ascertained. Associations were fit with zero-inflated negative binomial models, adjusted for age, sex, region, smoking, medication use, and comorbidities.
RESULTS: 5,722 individuals were identified. Higher HgbA1c was associated with higher asthma exacerbation rates. In the fully-adjusted model, compared to individuals with normal HbA1c, those in the pre-diabetes range had a 27% higher rate (95% CI, 5%-52%), and those in the diabetes range had a 33% higher rate (95% CI, 2%-73%).
CONCLUSION: Pre-diabetes and diabetes were associated with higher rates of asthma exacerbation among obese adults with asthma. Results support evidence that insulin resistance and metabolic syndrome, metabolic features common in pre-diabetes/diabetes, can influence asthma morbidity.
OBJECTIVE: We sought to determine the association between pre-diabetes/diabetes and asthma exacerbations in an obese asthma cohort.
METHODS: A retrospective cohort of US obese adults with asthma, age 18-64, was created from a claims-based health services database spanning 2010-2015. Individuals with a hemoglobin A1c (HbA1c) measurement were identified, categorized as within normal (<5.6%), pre-diabetes (5.7-6.4%), and diabetes (≥6.5%) ranges. Exacerbations, defined as asthma-related hospitalization, emergency department visit, or corticosteroid prescription ±14 days of an asthma-related outpatient visit, were ascertained. Associations were fit with zero-inflated negative binomial models, adjusted for age, sex, region, smoking, medication use, and comorbidities.
RESULTS: 5,722 individuals were identified. Higher HgbA1c was associated with higher asthma exacerbation rates. In the fully-adjusted model, compared to individuals with normal HbA1c, those in the pre-diabetes range had a 27% higher rate (95% CI, 5%-52%), and those in the diabetes range had a 33% higher rate (95% CI, 2%-73%).
CONCLUSION: Pre-diabetes and diabetes were associated with higher rates of asthma exacerbation among obese adults with asthma. Results support evidence that insulin resistance and metabolic syndrome, metabolic features common in pre-diabetes/diabetes, can influence asthma morbidity.
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