Higher HbA1C Levels Associated With Worse Pediatric Asthma Control

New research has found that higher HbA1c levels were associated with worse asthma control among children, supporting previous findings that metabolic dysfunction may influence asthma morbidity.1

“Insulin receptors have been identified in lung epithelial cells and may play a role in airway hyperresponsiveness, supporting the concept that obesity and asthma could be influenced by metabolic conditions such as diabetes and hyperglycemia. Previous studies have also shown an association between HbA1c and worsening asthma outcomes, including hospitalizations and exacerbations in adults; however, studies in children are lacking,” lead investigator Hewlett Pham, BS, Research Specialist at School of Medicine, University of California – San Francisco, and colleagues wrote.1

Pham and colleagues reported results from the AIRWEIGHS Study, a randomized controlled clinical trial of an air cleaner intervention evaluating improvements in asthma control in overweight/obese children compared to normal weight children. Investigators and assessed HbA1c levels and asthma outcomes at baseline and 3 months, categorizing HbA1c levels as either normal (< 5.7%) or consistent with pre-diabetes (≥ 5.7%). Other outcomes measured included standardized questionnaires, spirometry, and fractional exhaled nitric oxide (FeNO) and investigators analyzed the association between HbA1c levels and asthma outcomes with generalized Estimating Equation (GEE) regression models.

The study enrolled 164 children with asthma from Baltimore, Maryland, with an average age of 11 years (standard deviation [SD], 2), who were predominately African American (85%) and were mostly male (59%). Participants also had predominantly moderate or severe asthma by NAEPP criteria (59%), had households with an income below $34,999 (60%), were publicly insured (83%), and were overweight/obese (61%). Of the 164 participants, 52 were excluded from the analysis due to unsuccessful blood draws or participant refusal. Twenty of the remaining 112 (18%) had HbA1c measurements of at least 5.7%.

The investigators found that increased HbA1c levels were associated with an increase in the Asthma Therapy Assessment Questionnaire, indicating worse asthma control (β, 0.74; P <.05). Furthermore, interaction analysis revealed that BMI percentile had a significant interaction with HbA1c, with HbA1c having a stronger association with maximum symptoms days and exacerbation risk among children with lower versus higher BMI percentile values.

“In conclusion, we found that higher levels of HbA1c in children with asthma were associated with worse asthma control indicated by higher scores on the Asthma Therapy Assessment Questionnaire. In the BMI interaction analysis, we also found that HbA1c was associated with worse asthma symptoms and increased exacerbation risk among children with low BMI (5th percentile) compared to children with high BMI (95th percentile). Our findings add to the existing literature by demonstrating how poor glycemic control and underlying metabolic dysfunction can increase asthma morbidity in a population of children with asthma,” Pham and colleagues concluded.1

Other recent research looking to improve outcomes in children with asthma, especially from lower income backgrounds, evaluated a school-based asthma therapy program. The program yielded improvements in asthma control in children aged 5 to 19 and may benefit children with asthma in a wider setting.2

The investigators found that in 633 participants assessed, Asthma Control Test (ACT) increased by 37% and health care provider (HCP) scores increased by 56% (both P <.0001). Furthermore, asthma-related emergency department visits decreased by 49%, hospitalizations by 50%, PICU admissions by 71%, urgent care visits by 41%, and acute care visits by 38% (all P <.0001).2

“We help families get better adherence to kids’ asthma control medication regimens by having the school nurses give them their meds on the days that they go to school,” lead investigator Kimberly Arcoleo, PhD, professor at the Michigan State University College of Nursing, said in a statement.3

REFERENCES

1. Pham H, Koehl R, Woo H, Wu TD, Qiu AY, Brigham EP, Hansel NN, McCormack MC. Association Between Hemoglobin A1c and Pediatric Asthma Control. J Asthma Allergy. 2025;18:649-654. Doi: 10.2147/JAA.S498269

2. Arcoleo K, McGovern C, Allen E, et al. School-based asthma therapy: Improving medication adherence, asthma control, and health care utilization. J. Allergy Clin. Immunol. 2025; 4(2): 100428. doi: 10.1016/j.jacig.2025.100428

3. MSU research: School-based asthma therapy improves student health, lowers medical costs. News release. MSU. April 10, 2025. https://msutoday.msu.edu/news/2025/school-based-asthma-therapy-improves-student-health-lowers-medical-costs