|Year : 2015 | Volume
| Issue : 1 | Page : 28-31
Glycosylated hemoglobin levels and lipid profile in children with asthma using low dose and high dose inhaled corticosteroids
S Bindusha1, Saritha S Nair1, M Saboora Beegum2
1 Department of Paediatrics, Government Medical College, Thiruvananthapuram, Kerala, India
2 Department of Biochemistry, Government Medical College, Thiruvananthapuram, Kerala, India
|Date of Web Publication||17-Aug-2015|
Department of Paediatrics, Government Medical College, Thiruvananthapuram, Kerala
Source of Support: None, Conflict of Interest: None
Objective: To compare the mean Glycosylated haemoglobin level and lipid profile of children using high dose ICS with that of children using low dose ICS. Study Population: Children between 1-12 years attending asthma clinic using high dose and low dose inhaled corticosteroids. HbA1c levels, Fasting blood sugar and Lipid profile of children in the two groups were measured Results: Children belonging to low dose ICS group were using a mean dose of 206.02 ± 67.13 micrograms per day and high dose group were using a mean dose of 444.61 ± 70.33 micrograms per day. The mean glycosylated haemoglobin level was 6.206 ±1.36% among children using low dose inhaled steroids and 6.013 ± 1.185% among children using high dose inhaled steroids. The mean fasting cholesterol was 180.39 ± 28.66 mg/dl in the low dose ICS group and 179.17 ± 30.21 mg/dl in the high dose ICS group. The mean high density lipoprotein levels were 50.8 3 ±11.05 mg/dl among children using low dose inhaled steroids and 53.37 ± 13.36 mg/dl among children using high dose inhaled steroids. The mean low density lipoprotein levels were 111.78 ± 25.39 mg/dl among children using low dose inhaled steroids and 108.01 ± 30.26 mg/dl among children using high dose inhaled steroids. Conclusions: There was no statistically significant difference between the glycosylated haemoglobin levels, fasting blood glucose levels and fasting lipid profile between children on low dose inhaled corticosteroids and high dose inhaled corticosteroids.
Keywords: Cholesterol, glycosylated hemoglobin, inhaled steroids, lipid profile
|How to cite this article:|
Bindusha S, Nair SS, Beegum M S. Glycosylated hemoglobin levels and lipid profile in children with asthma using low dose and high dose inhaled corticosteroids. Indian J Allergy Asthma Immunol 2015;29:28-31
|How to cite this URL:|
Bindusha S, Nair SS, Beegum M S. Glycosylated hemoglobin levels and lipid profile in children with asthma using low dose and high dose inhaled corticosteroids. Indian J Allergy Asthma Immunol [serial online] 2015 [cited 2020 Jul 15];29:28-31. Available from: http://www.ijaai.in/text.asp?2015/29/1/28/162977
| Introduction|| |
Inhaled glucocorticoids are the drugs of choice in the long-term management of bronchial asthma due to their antiinflammatory action. Glucocorticoids have multiple effects on body metabolism, particularly carbohydrate and lipid metabolism. The inhaled corticosteroids (ICSs) have a better safety profile than the systemic steroids.  However, even the inhaled steroids can have significant adverse effects, especially at high doses and on long-term usage. The changes in blood glucose level with the use of ICSs have been studied. The level of glycosylated hemoglobin (HbA1c) reflects the summary of blood glucose level over a longer period of time. The changes in lipid profile with the use of ICSs have also been studied. However, reliable data from Indian children are not available.
| Materials and methods|| |
- To compare the mean HbA1c level and fasting blood sugar (FBS) level of children using high dose ICS with that of children using low dose ICS
- To compare the mean triglyceride, cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol and LDL: HDL ratio of children using high dose ICS with that of children using low dose ICS.
Asthma clinic of a Tertiary Care Teaching Hospital.
Children between 1 and 12 years attending asthma clinic.
- Children who are clinically diagnosed to have asthma, using low dose ICS (budesonide or fluticasone <400 μg/day) as metered dose inhaler with spacer ± mask, for at least 6 months
- Children who are clinically diagnosed to have asthma, using high dose ICS (budesonide or fluticasone ≥400 μg/day) as metered dose inhaler with spacer ± mask, for at least 6 months.
- Children using systemic glucocorticoids
- Children with diabetes mellitus, hypothyroidism
- Co existent pulmonary, cardiac or renal disease
- Children younger than 1-year and above 12 years
- Children who are noncompliant to treatment or use of spacer
- Children of parents who failed to give consent for the study.
HbA1c levels, FBS, and lipid profile of children in the two groups were measured. Anthropometric assessments of all children were done. Parents of the children were also interviewed with the help of a previously prepared questionnaire regarding severity of asthma, family, and personal history of atopic diseases, presence of diabetes mellitus in first and second degree relatives and presence of hyperlipidemia in first and second degree relatives. Results were analyzed using SPSS software (IBM, SPSS 17.0). The obtained results were compared between the groups by independent samples test. P < 0.05 is taken as significant. To find the influence of individual characteristics on the outcome regression analysis was done using ANOVA. The results are expressed as mean ± standard deviation.
Permission was obtained from the Ethical Committee before conducting the study. Informed consents were obtained from the parents.
| Results|| |
Among the children attending the asthma clinic during the study period, 185 children who satisfied the inclusion criteria were enrolled for the study. Among these 83 children were using ICSs in a dose below 400 mcg, at least for the past 6 months and were grouped as those using low dose ICS. One hundred and two children were using ICSs in a dose above 400 mcg and were grouped as those using high dose ICS.
The two study groups were comparable with respect to gender, age, the age of onset of symptoms, height, weight, and body mass index (BMI) [Table 1]. The two groups were also comparable in terms of asthma severity at diagnosis, drugs used to attain control, level of asthma control, presence of other allergic diseases, and family history of allergic diseases [Table 2].
Presence of other allergic diseases such as allergic rhinitis, conjunctivitis and atopic dermatitis were noticed in 19 children (22%) in the low dose ICS group and 37 children (36.3%) in the high dose ICS group. Sixty-four children (78%) in the low dose ICS group and 65 children (63.7%) in the high dose ICS group had no other allergic diseases. Thirty-eight children (44.4%) in the low dose group and 49 children (48%) in the high dose group reported at least one first-degree relative with allergic diseases including asthma. Forty-five children (55.6%) in the low dose group and 53 children (52%) in the high dose group did not have a family history of allergic diseases [Table 3].
Twenty-eight children (34.1%) in the low dose ICS group and 39 children (38.2%) in the high dose ICS group had at least one family member affected with diabetes mellitus. Twenty-six children (31.3%) in the low dose ICS group and 38 children (37.3%) in the high dose ICS group had a family history of hypertension. Thirteen children (15.7%) in the low dose ICS group and 11 children (10.8%) in the high dose ICS group had a family history of coronary artery disease. Eighteen children (21.7%) in the low dose ICS group and 32 children (31.4%) in the high dose ICS group had a family history of hypercholesterolemia.
The two groups differed with respect to the current dose of inhaled steroids used, duration of steroid use and the cumulative amount of inhaled steroids used in the last 6 months [Table 4]. Children belonging to low dose ICS group were using a mean dose of 206.02 μg/day while children in the high dose group were using a mean dose of 444.61 μg/day. The mean duration of inhaled steroid use was 2.621 ± 1.56 years for the children in the low dose ICS group and 1.851 ± 1.245 years for the children in the high dose ICS group. A group of the patients in the low dose group were on tapering the dose of ICS after obtaining control of asthma symptoms. Hence, the mean duration of ICS use was higher for the low dose group. The mean amount of inhaled steroids used within the last 6 months was 37.69 ± 13.00 milligrams for children in the low dose group and 80.03 ± 12.66 milligrams for children in the high dose group.
The mean HbA1c levels, fasting blood glucose levels, S. Cholesterol levels, Triglyceride levels, LDL levels, HDL levels, very LDL (VLDL) levels and HDL: LDL ratios of the two groups were calculated [Table 5] and [Table 6].
Multiple regression analysis was performed to find the effect of age at onset of symptoms, duration of ICS use, cumulative dose of ICS used, severity of asthma, type of inhaled steroids used, recent use of short-acting beta agonists, use of long-acting beta agonists, BMI and family history of diabetes and hypercholesterolemia on HbA1c levels and lipid profile. BMI was found to correlate with Triglyceride level (P = 0.01) and VLDL level (P = 0.003). Other characteristics did not correlate with the HbA1c levels and lipid profile.
| Discussion|| |
Previous studies have demonstrated an increase in HbA1c levels after administration of ICSs. Yucel et al. found that HbA1c levels were higher in 141 children with asthma using low dose ICSs than 52 children without asthma 5.44 versus 5.14 (P = 0.006). , They also found that the level of HbA1c has no relation with cumulative dose and duration of ICS. Turpeinen et al. found that serum insulin : g0 lucose ratio increased in nine children while using 800 mcg/m 2 ICSs (P = 0.016), than when they were on 400 mcg/m 2 .  However, this study is limited by the inadequate sample size. Kiviranta and Turpeinen found that in adult patients stressed by uncontrolled asthma, the antiasthmatic effect of high dose beclomethasone dipropionate and budesonide was accompanied by a significant initial decrease in insulin resistance with a parallel improvement in glucose tolerance.  They suggested that the overall effect of ICSs on carbohydrate metabolism may be beneficial in patients with uncontrolled asthma.
In the present study, the mean HbA1c level was 6.206 ± 1.365% among children using low dose inhaled steroids and 6.013 ± 1.185% among children using high dose inhaled steroids (P = 0.305). The mean FBS was 88.05 ± 12.91 mg/dl among children using low dose inhaled steroids and 86.42 ± 15.58 mg/dl among children using high dose inhaled steroids (P = 0.447). No statistically significant difference was found between the mean HbA1c levels and the mean FBS levels of the children using a low dose and high dose inhaled steroids.
Turpeinen et al. found that serum HDL cholesterol increased significantly by 22% when children were on a dose of 800 mcg/m 2 (medians: 1.18 vs. 1.44 mmol/L) and declined to 1.31 mmol/L when the dose was reduced to 400 mcg/m 2 (Overall P = −0.0319).  Yavuz et al. found no significant change of serum fasting triglyceride concentrations (P > 0.05) in 11 asthmatic patients on high dose inhaled steroids.  They demonstrated that serum fasting cholesterol concentration decreased slightly (P = 0.03) and HDL-cholesterol concentrations increased (P = 0.01).
In the present study, there was no statistically significant difference between the lipid profile of the children using low dose inhaled steroids, and high dose inhaled steroids [Table 6]. The previous studies have demonstrated an increase in HDL levels in children and adults using inhaled steroids. , The difference in the HDL levels between the two groups was only 2.5 mg/dl in the present study and was not found to be significant.
The present study is a cross-sectional study and hence limited by the nonavailability of baseline HbA1c levels and lipid profile of these children before starting the ICS treatment.
| Conclusion|| |
There was no statistically significant difference between the HbA1c levels, fasting blood glucose levels, and fasting lipid profile between children on low dose ICSs and high dose ICSs. Increasing the daily dose of inhaled steroids to 400 μg will not significantly alter the carbohydrate or lipid metabolism in children with asthma.
Financial support and sponsorship
State Board of Medical Research, Kerala.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Donnelly R, Seale JP. Clinical pharmacokinetics of inhaled budesonide. Clin Pharmacokinet 2001;40:427-40.
Yucel O, Eker Y, Nuhoglu C, Ceran O. Hemoglobin a1c levels in children with asthma using low dose inhaled corticosteroids. Indian Pediatr 2009;46:300-3.
Lodha R, Kabra SK. Do inhaled corticosteroids adversely influence glucose metabolism. Indian Pediatr 2009;46:293-4.
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 (3 Pt 1):384-9.
Kiviranta K, Turpeinen M. Effect of eight months of inhaled beclomethasone dipropionate and budesonide on carbohydrate metabolism in adults with asthma. Thorax 1993;48:974-8.
Yavuz O, Türktas I, Cevik C. The effect of high-dose inhaled budesonide on lipid profile in asthmatic patients. Gen Pharmacol 1996;27:89-90.
Ulubas B, Cimen F, Eryilmaz T, Bugdayci R, Calikoglu M. Lipid profile in patients with chronic obstructive pulmonary disease. Turk Respir J 2003;4:120-2. Available from:toraks.dergisi.org/trj/pdf/pdf_TRJ_339.pdf.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]