Work

Impact of Asthma and Corticosteroid Exposure on Glycemic Markers in Overweight and Obese Children

Year: 2026

Type: article

Abstract: Purpose: Corticosteroids are the cornerstone of asthma management, yet they are associated with hyperglycemia and insulin resistance. This study evaluated associations between asthma characteristics and glycemic markers in children with overweight or obesity and examined whether corticosteroid exposure modifies these associations. Methods: This cross-sectional study included 199 children aged 6– 17 years with overweight or obesity from the Middle East and North Africa region. They were divided into two groups: with asthma (OO-A) (N = 100) and without asthma (OO) (N = 99). Asthma phenotype was classified as type 2 (blood eosinophils ≥ 300 cells/μL, FeNO ≥ 30 ppb, or confirmed allergy) or non-type 2 asthma. Asthma severity was classified based on FEV 1 % predicted: mild (≥ 80%), moderate (60% to < 80%), and severe (< 60%). Linear and logistic regression models assessed associations between asthma characteristics and glycemic markers in the circulation before and after adjusting for corticosteroid use. Results: Asthma was associated with higher HbA1c (β = 0.152, p = 0.007) and prediabetes (HbA1c ≥ 5.7%) (OR = 2.69, p = 0.026) only when not adjusting for corticosteroid use. Mediation analysis showed that corticosteroid exposure may account for 45.4% of the total effect of asthma on HbA1c (p = 0.024). The OO group had a higher prevalence of insulin resistance (HOMA-IR ≥ 2.5) (p = 0.029). Type 2 asthma was associated with higher HbA1c without corticosteroid adjustment (β = 0.176, p = 0.002), which was attenuated after corticosteroid adjustment (β = 0.116, p = 0.057). Severe asthma remained significantly associated with higher HbA1c in both models regardless of corticosteroid adjustment (β = 0.347– 0.409, p < 0.05). No consistent associations were found with other glycemic markers. Conclusion: The asthma–HbA1c association in children with overweight/obesity may be largely mediated by corticosteroid use. Severe asthma may have a direct association with HbA1c independent of steroid use. Given the cross-sectional design and limited sample sizes, these findings require confirmation in larger longitudinal studies with more precise assessments of corticosteroid exposure and other confounders to clarify causal pathways and to evaluate whether optimizing asthma management while minimizing corticosteroid exposure could reduce long-term metabolic risk in this vulnerable population. Keywords: HbA1c, corticosteroids, pediatrics, BMI, childhood asthma

Source: Diabetes Metabolic Syndrome and Obesity

DOI: 10.2147/dmso.s614951