Asthma Can Complicate Diabetes Care in Kids

Children hit with the double whammy of type 1 diabetes and asthma have an especially tough time keeping their blood sugar under control, a new study finds.

The reason why asthma might complicate pediatric diabetes care remains unclear, however, and is "something that needs to be explored more," said Dr. Anita Swamy, a pediatric endocrinologist and medical director of the Chicago Children's Diabetes Center at La Rabida Children's Hospital in Chicago.

She was not involved in the new study, which appears in the October issue of Pediatrics.

About 215,000 children in the United States have diabetes, according to the U.S. Centers for Disease Control and Prevention. Most children who have diabetes have type 1 diabetes, although type 2 diabetes is becoming more prevalent in kids. Type 1 diabetes is an autoimmune disease that causes the body to mistakenly attack the insulin-producing cells in the pancreas. Insulin is a hormone that helps the body process carbohydrates in food. Type 2 diabetes occurs when the body doesn't produce enough insulin, or when it stops using insulin effectively, according to the American Diabetes Association.

Asthma is a chronic disease that causes inflammation in the airways, and when someone with asthma is exposed to a trigger, the disease causes the muscles in the lungs to tighten, making breathing very difficult. About 7 million American children have asthma, the CDC reports.

According to the new study, which was led by Mary Helen Black of Kaiser Permanente Southern California, about 11 percent of children with diabetes also struggle with asthma. Her team theorized that the inflammation that's present with untreated asthma might make it harder to control blood sugar levels.

The study tracked almost 1,700 children diagnosed with type 1 diabetes and 311 diagnosed with type 2 diabetes between 2002 and 2005, and found that 10 percent of those children with type 1 diabetes and just over 16 percent of those with type 2 diabetes also had asthma.

In kids with type 1 diabetes, the average hemoglobin A1C levels were about 7.5 for children without asthma and 7.8 for those with asthma. A1C is a test that measures long-term blood sugar control. The higher the number, the higher the average blood sugar was. Non-diabetic people generally have an A1C below 6.

Overall, kids with type 1 diabetes and asthma were 37 percent more likely to have poor glycemic [blood sugar] control than to have good control, compared to children without the respiratory ailment. "Among youth with type 1 diabetes, asthma is associated with poor glycemic control, especially if asthma is untreated," the study authors concluded.

However, they did not find a statistically significant link between type 2 diabetes and asthma control. That might be because they had fewer children in the study with both of those conditions, the team suggested.

The use of asthma medications significantly impacted blood sugar control, reported the researchers. Seventy-two percent of children with type 1 diabetes and asthma who were treated with leukotriene modifiers (brand names are Accolate, Singulair, Zyflo) achieved good blood sugar control, according to the study. Leukotriene modifiers are preventive medications that need to be taken every day. They're not available in generic forms.

Still, one expert was skeptical of a true physiological link between asthma and blood sugar control.

"I don't think there's any biology behind this association," said Dr. Juan Celedon, chief of service, division of pediatric pulmonology, allergy and immunology at Children's Hospital of Pittsburgh. Instead, he said, "the ones taking these medications are the ones with better insurance and access to quality health care."

And, that's Celedon's issue with the study as a whole. "My concern is that there is confounding by socioeconomic status and access to health care. They needed to adjust the data for more things. When they adjusted for race and ethnicity, the associations went down. And, children with untreated asthma and poor glycemic control may be the kids who aren't getting adequate health care," he explained.

Swamy agreed, adding, "this is one of those studies that finds an association, but it's hard to know if it's causal. We don't know why they're linked."

In the meantime, she also pointed out that some asthma medications can raise blood sugar levels, which could affect blood sugar control if parents and children aren't aware of that possibility.

Corticosteroids, especially oral steroids, can raise blood sugar levels, though Swamy said recent research has noted a link between inhaled corticosteroids and higher blood sugar levels. Certain asthma rescue medications -- inhaled medications known as beta-agonists -- can also raise blood sugar levels, according to Swamy.

"I tell primary care doctors to let us [endocrinologists] know when a child with asthma and diabetes needs a change in medications. If I know, I can preemptively change the insulin regimen and blood sugar control can still be good. The same goes for when a child has an asthma flare," said Swamy.

She added that parents shouldn't hesitate to call their child's diabetes health care team to find out what changes, if any, need to be made to their child's insulin regimen to account for asthma medications.

More information

Learn more about asthma medications from the American Academy of Allergy, Asthma and Immunology.

Broccoli, Cabbage, Other Veggies May Protect Against Colon Cancer

Eating fruits and vegetables may reduce the risk of some colorectal cancers, according to a new study.

Austrailian researchers examined the diets of 918 colorectal cancer patients and 1,021 people with no history of the disease and found that consumption of certain vegetables and fruits were associated with a decreased risk of cancer in the proximal and distal colon -- that is, the upper and lower portions of the colon.

Consumption of brassica vegetables (also known as cole crops) such as broccoli, kale, cauliflower, turnips and cabbage, for example, appeared to reduce the risk of cancer in the upper colon, while both total fruit and vegetable intake (and total vegetable intake alone) reduced the risk of cancer in the lower colon.

They also found that eating more apples and dark, yellow vegetables was linked with a significantly reduced risk of lower colon cancer.

Yet higher levels of fruit juice consumption were associated with an increased risk for rectal cancer.

The study appears in the October issue of the Journal of the American Dietetic Association.

"Fruits and vegetables have been examined extensively in nutritional research in relation to CRC (colorectal cancer), however, their protective effect has been subject to debate, possibly because of different effects on different subsites of the large bowel," lead investigator Professor Lin Fritschi, head of the Epidemiology Group at the Western Australian Institute for Medical Research, said in a journal news release.

"It may be that some of the confusion about the relationship between diet and cancer risk is due to the fact that previous studies did not take site of the [colorectal cancer] into account. The replication of these findings in large prospective studies may help determine whether a higher intake of vegetables is a means for reducing the risk" of cancer in the lower colon, Fritschi concluded.

More information

The U.S. National Cancer Institute has more about colorectal cancer prevention.

Remicade Approved for Ulcerative Colitis in Children

Remicade (infliximab) has been approved by the U.S. Food and Drug Administration to treat moderate-to-severe active episodes of ulcerative colitis in children aged six and older who haven't responded to other therapies.

UC, a form of inflammatory bowel disease, attacks the lining of the large intestine and rectum. Symptoms may include abdominal pain, diarrhea, rectal bleeding, loss of weight and fever. Some 40 percent of the 50,000 to 100,000 children in the United States with inflammatory bowel disease have UC, the FDA said in a news release.

Remicade is a tumor necrosis factor blocker, which suppresses a bodily substance that causes inflammation and plays a role in so-called autoimmune diseases, in which the overactive immune system attacks the body itself.

Remicade has been FDA approved to treat UC in adults and to fight other autoimmune diseases among adults and children, including Crohn's disease, rheumatoid arthritis, plaque psoriasis, psoriatic arthritis and ankylosing spondylitis, the FDA said.

The drug carries a boxed label warning for increased risk of cancer and serious infections including tuberculosis, the agency said. As such, children should have all recommended vaccines before starting Remicade, the FDA said.

Other side effects of Remicade may include worsening of some UC symptoms and headache, the agency said.

Remicade is produced by Janssen Biotech, based in Malvern, Penn.

More information

To learn more about UC, visit Medline Plus.

Certain Antidepressants With Blood Thinners May Pose Risk for Heart Patients

Heart attack patients who take both selective serotonin reuptake inhibitor (SSRI) antidepressants and antiplatelet drugs such as aspirin or Plavix have a higher risk for bleeding than those who take anti-clotting drugs only, a new study finds.

Commonly prescribed SSRIs include Zoloft, Prozac, Paxil and Lexapro.

Antiplatelet drugs prevent blood cells from sticking together and forming a blood clot. Heart attack patients are commonly prescribed antiplatelet therapy to reduce their risk of another heart attack. But there's an increased risk of bleeding, which increases even further when certain other drugs are taken at the same time.

It so happens that many heart attack patients have depression symptoms and are prescribed antidepressants, noted the researchers at McGill University in Montreal.

"We're always concerned about how other medicines might interact with the medicines we know are essential to heart health and recovery after heart attack," said Dr. Kirk Garratt, clinical director of interventional cardiovascular research at Lenox Hill Hospital in New York City. "Although SSRIs are used in only a few cardiac patients, learning that SSRIs can increase [the] risk of bleeding complications could have important implications for how we care for patients after stents and other heart procedures."

In the Canadian study, the researchers looked at more than 27,000 heart attack patients, aged 50 and older, and found that patients taking aspirin or Plavix alone had a similar risk of bleeding. But taking an SSRI antidepressant and aspirin increased the risk of bleeding by 42 percent, and taking an SSRI with both aspirin and clopidogrel (dual antiplatelet therapy) increased the risk by 57 percent.

Bleeding included gastrointestinal bleeding, hemorrhagic stroke or other bleeding that required hospitalization or occurred in the hospital during treatment.

The researchers also found that the risk of bleeding was lower in women and in patients who had angioplasty after their heart attack.

The study appears Sept. 26 in the Canadian Medical Association Journal.

"Ultimately, clinicians must weigh the benefits of SSRI therapy against the risk of bleeding in patients with major depression following acute myocardial infarction," the researchers wrote in a journal news release.

They urged doctors to be cautious when prescribing antidepressants to heart attack patients on antiplatelet therapy.

More information

The Texas Heart Institute has more about antiplatelet therapy.