1/6/11

Type 2 Diabetes Independently Predicts Asthma Risk

News Author: Frederik Joelving
CME Author: Désirée Lie, MD, MSEd
CME Released: 12/10/2010; Valid for credit through 12/10/2011


Source:
http://www.medscape.org/viewarticle/734002?src=cmemp


NEW YORK (Reuters Health) December 10, 2010 — Patients with type 2 diabetes have nearly twice the risk of asthma vs non-diabetics, a Danish twin study shows.
The link remained after adjusting for several confounders, including BMI and chronic bronchitis, researchers report online November 17 in Allergy. BMI, on the other hand, independently predicted asthma only in women.
"More and more evidence is emerging that asthma — possibly mostly adult asthma — has a strong metabolic component with systemic cross-talk with inflammation of fat tissue," Dr. Simon Francis Thomsen of Bispebjerg Hospital in Copenhagen told Reuters Health in an e-mail.
"This is interesting since asthma previously has been regarded as an allergic disease and much less focus has been given to other aspects of its etiology and pathogenesis," he added. "If asthma results in part from metabolic disturbances, prevention could be possible through healthy activities relating to exercise and diet."
Dr. Thomsen and colleagues linked data from the Danish Twin Registry to the Danish National Patient Registry, resulting in a sample of nearly 35,000 twins 20 to 71 years old.
The self-reported asthma rate was 8.7%, while 8.1% were obese with a BMI of at least 30. Based on hospital records, the rate of type 2 diabetes was 1.3%, although the authors recognize that this estimate may be too small.
Asthma was more common in diabetics than in non-diabetics, both in men (13.5% vs. 7.5%) and women (16.6% vs. 9.6%). After adjusting for age, BMI, smoking, marital status, bronchitis and zygosity, the odds ratios for asthma were 1.70 (p=0.026) in male and 1.88 (p=0.003) in female diabetics.
BMI independently predicted asthma only in women (p<0.000).
Both links were attenuated in monozygotic as compared with dizygotic twins when analyzing discordant twin pairs, suggesting some degree of genetic confounding.
The researchers report that genetic factors accounted for 62% of the variance in susceptibility to asthma, 74% for type 2 diabetes, and 73% for BMI. Shared environmental factors, on the other hand, did not play a role.
"Like prior studies, this research suggests that there are common genetic factors for asthma and obesity, and extend these observations to include common genetic factors with type 2 diabetes," said Dr. Teal S. Hallstrand of the University of Washington in Seattle, adding that it's still unknown whether diabetes treatment has an effect on asthma.
"In a study with obese db/db mice that are susceptible to features of asthma and have hyperglycemia, treatment with metformin to reduce the blood sugar did not affect either airway hyper-responsiveness or airway inflammation," he told Reuters Health in an e-mail. "Thus the cause and effect relationship with diabetes is uncertain."
Still, he noted, "Doctors should be aware of the potential for diabetes in obese patients with asthma."
Allergy. Published online November 17, 2010.


Clinical Context



Previous studies have found an association between asthma and increased body weight, but it is unclear if other metabolic risk factors such as type 2 diabetes also increase the risk for asthma. Also, little is known about the association between asthma and diabetes at the population level.
This is a population-based study of twins using record linkage between questionnaire-identified asthma and BMI and hospital diagnoses of diabetes in Danish twins in a longitudinal cohort.

Study Highlights




  • Included were twins born between 1931 and 1982 who were registered in the Danish Twin Registry.
  • The twins responded to a questionnaire about health and lifestyle habits in 2002.
  • 34,782 twin individuals answered the questionnaire that included a history of asthma.
  • Twin zygosity was determined by 4 questions.
  • BMI was calculated.
  • A diagnosis of type 2 diabetes was obtained from the Danish National Patient Registry, which records all hospitalizations in Denmark since 1977.
  • The risk for asthma was calculated with logistic regression analysis for unpaired data, and latent factor models were used to analyze data.
  • The sample had more women than men (54%). More women had a history of asthma (9.7% vs 7.6%), whereas more men than women had diabetes (1.5% vs 1.2%).
  • More men were obese than women (8.7% vs 7.6%).
  • The mean BMI was 23.7 kg/m2 in women and 25.4 kg/m2 in men.
  • The prevalence of diabetes increased with age and obesity (0.7% in those with BMI < 25 kg/m2 and 9.1% in those with BMI ≥ 35 kg/m2).
  • The prevalence of obesity was 32.4% among those with diabetes and 7.8% among those without diabetes.
  • The prevalence of asthma was not significantly different between monozygotic and dizygotic twins.
  • The risk for asthma was significantly increased in those with diabetes vs those without diabetes for both men (13.5% vs 7.5%) and women (16.6% vs 9.6%).
  • The risk for asthma also increased linearly with increasing BMI.
  • After adjustment for bronchitis, BMI, smoking, marital status, and zygosity, diabetes remained a significant risk factor for asthma in men (HR, 1.70; P = .026) and in women (HR, 1.88; P = .003).
  • BMI remained an independent predictor of asthma risk in women, but not in men, after adjustment for confounders.
  • Among discordant twin pairs, the twin with the highest BMI had the highest risk for asthma (sex-adjusted OR, 1.13), but this finding was significant for dizygotic, but not monozygotic, twins.
  • Shared environment did not significantly influence disease susceptibility for asthma.
  • The authors concluded that the risk for asthma was almost doubled in men and women with diabetes vs individuals without diabetes and that BMI and diabetes were both metabolic risk factors for asthma.
  • They noted that asthma, diabetes, and increased BMI were strongly related especially in women, independent of smoking, age, and chronic bronchitis, suggesting a common cause for asthma and metabolic syndrome.


Clinical Implications



  • The risk for asthma is increased in men and women with type 2 diabetes vs those without diabetes.
  • Both increased BMI and type 2 diabetes are independent metabolic risk factors for asthma.


regards, taniafdi ^_^
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1/6/11

Type 2 Diabetes Independently Predicts Asthma Risk

News Author: Frederik Joelving
CME Author: Désirée Lie, MD, MSEd
CME Released: 12/10/2010; Valid for credit through 12/10/2011


Source:
http://www.medscape.org/viewarticle/734002?src=cmemp


NEW YORK (Reuters Health) December 10, 2010 — Patients with type 2 diabetes have nearly twice the risk of asthma vs non-diabetics, a Danish twin study shows.
The link remained after adjusting for several confounders, including BMI and chronic bronchitis, researchers report online November 17 in Allergy. BMI, on the other hand, independently predicted asthma only in women.
"More and more evidence is emerging that asthma — possibly mostly adult asthma — has a strong metabolic component with systemic cross-talk with inflammation of fat tissue," Dr. Simon Francis Thomsen of Bispebjerg Hospital in Copenhagen told Reuters Health in an e-mail.
"This is interesting since asthma previously has been regarded as an allergic disease and much less focus has been given to other aspects of its etiology and pathogenesis," he added. "If asthma results in part from metabolic disturbances, prevention could be possible through healthy activities relating to exercise and diet."
Dr. Thomsen and colleagues linked data from the Danish Twin Registry to the Danish National Patient Registry, resulting in a sample of nearly 35,000 twins 20 to 71 years old.
The self-reported asthma rate was 8.7%, while 8.1% were obese with a BMI of at least 30. Based on hospital records, the rate of type 2 diabetes was 1.3%, although the authors recognize that this estimate may be too small.
Asthma was more common in diabetics than in non-diabetics, both in men (13.5% vs. 7.5%) and women (16.6% vs. 9.6%). After adjusting for age, BMI, smoking, marital status, bronchitis and zygosity, the odds ratios for asthma were 1.70 (p=0.026) in male and 1.88 (p=0.003) in female diabetics.
BMI independently predicted asthma only in women (p<0.000).
Both links were attenuated in monozygotic as compared with dizygotic twins when analyzing discordant twin pairs, suggesting some degree of genetic confounding.
The researchers report that genetic factors accounted for 62% of the variance in susceptibility to asthma, 74% for type 2 diabetes, and 73% for BMI. Shared environmental factors, on the other hand, did not play a role.
"Like prior studies, this research suggests that there are common genetic factors for asthma and obesity, and extend these observations to include common genetic factors with type 2 diabetes," said Dr. Teal S. Hallstrand of the University of Washington in Seattle, adding that it's still unknown whether diabetes treatment has an effect on asthma.
"In a study with obese db/db mice that are susceptible to features of asthma and have hyperglycemia, treatment with metformin to reduce the blood sugar did not affect either airway hyper-responsiveness or airway inflammation," he told Reuters Health in an e-mail. "Thus the cause and effect relationship with diabetes is uncertain."
Still, he noted, "Doctors should be aware of the potential for diabetes in obese patients with asthma."
Allergy. Published online November 17, 2010.


Clinical Context



Previous studies have found an association between asthma and increased body weight, but it is unclear if other metabolic risk factors such as type 2 diabetes also increase the risk for asthma. Also, little is known about the association between asthma and diabetes at the population level.
This is a population-based study of twins using record linkage between questionnaire-identified asthma and BMI and hospital diagnoses of diabetes in Danish twins in a longitudinal cohort.

Study Highlights




  • Included were twins born between 1931 and 1982 who were registered in the Danish Twin Registry.
  • The twins responded to a questionnaire about health and lifestyle habits in 2002.
  • 34,782 twin individuals answered the questionnaire that included a history of asthma.
  • Twin zygosity was determined by 4 questions.
  • BMI was calculated.
  • A diagnosis of type 2 diabetes was obtained from the Danish National Patient Registry, which records all hospitalizations in Denmark since 1977.
  • The risk for asthma was calculated with logistic regression analysis for unpaired data, and latent factor models were used to analyze data.
  • The sample had more women than men (54%). More women had a history of asthma (9.7% vs 7.6%), whereas more men than women had diabetes (1.5% vs 1.2%).
  • More men were obese than women (8.7% vs 7.6%).
  • The mean BMI was 23.7 kg/m2 in women and 25.4 kg/m2 in men.
  • The prevalence of diabetes increased with age and obesity (0.7% in those with BMI < 25 kg/m2 and 9.1% in those with BMI ≥ 35 kg/m2).
  • The prevalence of obesity was 32.4% among those with diabetes and 7.8% among those without diabetes.
  • The prevalence of asthma was not significantly different between monozygotic and dizygotic twins.
  • The risk for asthma was significantly increased in those with diabetes vs those without diabetes for both men (13.5% vs 7.5%) and women (16.6% vs 9.6%).
  • The risk for asthma also increased linearly with increasing BMI.
  • After adjustment for bronchitis, BMI, smoking, marital status, and zygosity, diabetes remained a significant risk factor for asthma in men (HR, 1.70; P = .026) and in women (HR, 1.88; P = .003).
  • BMI remained an independent predictor of asthma risk in women, but not in men, after adjustment for confounders.
  • Among discordant twin pairs, the twin with the highest BMI had the highest risk for asthma (sex-adjusted OR, 1.13), but this finding was significant for dizygotic, but not monozygotic, twins.
  • Shared environment did not significantly influence disease susceptibility for asthma.
  • The authors concluded that the risk for asthma was almost doubled in men and women with diabetes vs individuals without diabetes and that BMI and diabetes were both metabolic risk factors for asthma.
  • They noted that asthma, diabetes, and increased BMI were strongly related especially in women, independent of smoking, age, and chronic bronchitis, suggesting a common cause for asthma and metabolic syndrome.


Clinical Implications



  • The risk for asthma is increased in men and women with type 2 diabetes vs those without diabetes.
  • Both increased BMI and type 2 diabetes are independent metabolic risk factors for asthma.


regards, taniafdi ^_^
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