Association Between Prediabetes/Diabetes and Asthma Exacerbations in a Claims-Based Obese Asthma Cohort

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Abstract

Background: Metabolic dysfunction may contribute to worsened asthma in obesity. The relationship between prediabetes and diabetes, metabolic conditions more common in obesity, and asthma outcomes is not well characterized. Objective: We sought to determine the association between prediabetes/diabetes and asthma exacerbations in an obese asthma cohort. Methods: A retrospective cohort of US obese adults with asthma, aged 18-64, was created from a claims-based health services database spanning 2010 to 2015. Individuals with a hemoglobin A1c (HbA1c) measurement were identified, categorized as within normal (<5.6%), prediabetes (5.7% to 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: A total of 5722 individuals were identified. Higher HgbA1c was associated with higher asthma exacerbation rates. In the fully adjusted model, compared with individuals with normal HbA1c, those in the prediabetes range had a 27% higher rate (95% confidence interval [CI], 5% to 52%), and those in the diabetes range had a 33% higher rate (95% CI, 2% to 73%). Conclusions: Prediabetes 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 prediabetes/diabetes, can influence asthma morbidity.

Original languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology: In Practice
DOIs
StatePublished - Jan 1 2019

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Prediabetic State
Asthma
Hemoglobins
Obesity
Confidence Intervals
Statistical Models
Health Services
Prescriptions
Insulin Resistance
Hospital Emergency Service
Comorbidity
Adrenal Cortex Hormones
Hospitalization
Outpatients
Smoking

Keywords

  • Administrative
  • Asthma
  • Claims
  • Diabetes
  • Exacerbation
  • Hemoglobin A1c
  • Metabolic dysfunction
  • Prediabetes

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

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title = "Association Between Prediabetes/Diabetes and Asthma Exacerbations in a Claims-Based Obese Asthma Cohort",
abstract = "Background: Metabolic dysfunction may contribute to worsened asthma in obesity. The relationship between prediabetes and diabetes, metabolic conditions more common in obesity, and asthma outcomes is not well characterized. Objective: We sought to determine the association between prediabetes/diabetes and asthma exacerbations in an obese asthma cohort. Methods: A retrospective cohort of US obese adults with asthma, aged 18-64, was created from a claims-based health services database spanning 2010 to 2015. Individuals with a hemoglobin A1c (HbA1c) measurement were identified, categorized as within normal (<5.6{\%}), prediabetes (5.7{\%} to 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: A total of 5722 individuals were identified. Higher HgbA1c was associated with higher asthma exacerbation rates. In the fully adjusted model, compared with individuals with normal HbA1c, those in the prediabetes range had a 27{\%} higher rate (95{\%} confidence interval [CI], 5{\%} to 52{\%}), and those in the diabetes range had a 33{\%} higher rate (95{\%} CI, 2{\%} to 73{\%}). Conclusions: Prediabetes 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 prediabetes/diabetes, can influence asthma morbidity.",
keywords = "Administrative, Asthma, Claims, Diabetes, Exacerbation, Hemoglobin A1c, Metabolic dysfunction, Prediabetes",
author = "Wu, {Tianshi David} and Emily Brigham and Corinne Keet and Brown, {Todd T} and Nadia Hansel and Meredith McCormack",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jaip.2019.02.029",
language = "English (US)",
journal = "Journal of Allergy and Clinical Immunology: In Practice",
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publisher = "Elsevier",

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T1 - Association Between Prediabetes/Diabetes and Asthma Exacerbations in a Claims-Based Obese Asthma Cohort

AU - Wu, Tianshi David

AU - Brigham, Emily

AU - Keet, Corinne

AU - Brown, Todd T

AU - Hansel, Nadia

AU - McCormack, Meredith

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Metabolic dysfunction may contribute to worsened asthma in obesity. The relationship between prediabetes and diabetes, metabolic conditions more common in obesity, and asthma outcomes is not well characterized. Objective: We sought to determine the association between prediabetes/diabetes and asthma exacerbations in an obese asthma cohort. Methods: A retrospective cohort of US obese adults with asthma, aged 18-64, was created from a claims-based health services database spanning 2010 to 2015. Individuals with a hemoglobin A1c (HbA1c) measurement were identified, categorized as within normal (<5.6%), prediabetes (5.7% to 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: A total of 5722 individuals were identified. Higher HgbA1c was associated with higher asthma exacerbation rates. In the fully adjusted model, compared with individuals with normal HbA1c, those in the prediabetes range had a 27% higher rate (95% confidence interval [CI], 5% to 52%), and those in the diabetes range had a 33% higher rate (95% CI, 2% to 73%). Conclusions: Prediabetes 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 prediabetes/diabetes, can influence asthma morbidity.

AB - Background: Metabolic dysfunction may contribute to worsened asthma in obesity. The relationship between prediabetes and diabetes, metabolic conditions more common in obesity, and asthma outcomes is not well characterized. Objective: We sought to determine the association between prediabetes/diabetes and asthma exacerbations in an obese asthma cohort. Methods: A retrospective cohort of US obese adults with asthma, aged 18-64, was created from a claims-based health services database spanning 2010 to 2015. Individuals with a hemoglobin A1c (HbA1c) measurement were identified, categorized as within normal (<5.6%), prediabetes (5.7% to 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: A total of 5722 individuals were identified. Higher HgbA1c was associated with higher asthma exacerbation rates. In the fully adjusted model, compared with individuals with normal HbA1c, those in the prediabetes range had a 27% higher rate (95% confidence interval [CI], 5% to 52%), and those in the diabetes range had a 33% higher rate (95% CI, 2% to 73%). Conclusions: Prediabetes 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 prediabetes/diabetes, can influence asthma morbidity.

KW - Administrative

KW - Asthma

KW - Claims

KW - Diabetes

KW - Exacerbation

KW - Hemoglobin A1c

KW - Metabolic dysfunction

KW - Prediabetes

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