≥3 respiratory symptoms§ Diabetes mellitus and asthma: a cross-sectional survey Rajkumar H1, Macsali F1,2 , Svanes C 2, Omenaas ER2, Norbäck D3, Lindberg E3, Jõgi R4, Franklin KA5, Gislason T6, Torén K7, Schlünssen V8, Janson C3, Gómez Real F1 1 Dept Gyn Obst, Haukeland Univ Hosp, Bergen, Norway 2 Inst Med, Bergen Univ 3 Dept Med Sci, Uppsala Univ, Sweden 4 Lung Clinic, Tartu Univ, Estonia 5 Dept Pulm Med Umeå Univ, Sweden 6 Dept Pulm Med, Reykjavik Univ, Iceland 7 Dept Occup Env Med, Sahlgrenska Univ, Sweden 8 Dept Env Occup Med, Aarhus Univ, Denmark BACKGROUND RESULTS TABLE 2. Characteristics of the study population according to the presence of recalled doctor-diagnosed diabetes or not There is growing awareness that asthma might be related to systemic inflammation and metabolic factors, while there is limited information about the association of diabetes with asthma. Self-reported diabetes was associated with asthma (OR=1.63 [95% CI=1.05-2.54]), wheeze (1.77 [1.32-2.37]), having three or more asthma symptoms (1.58 [1.14-2.19]), and hay fever (1.34 [0.99-1.81]), but not with chronic bronchitis (0.80 [0.425-1.51]). no diabetes* (n=13568) diabetes* (n=231) p-value Age (median, years) 40 44 0.00** Gender 0.6 -women n (%) ♀ 7228 119 (1.62) -men n (%) ♂ 6340 112 (1.74) BMI (median, kg/m2) 24.3 26.3 Smoking status: 0.02 - Current smokers (%) 28 35 - Ex-smokers (%) 25 26 - Never smokers (%) 47 38 Dwelling: 0.04 - Detached house 42 39 - Semidetached house 15 11 - Apartment 41 49 - Other 1.61 0.44 OBJECTIVES We aimed to investigate whether diabetes was related to asthma in general populations from Northern Europe. FIGURE: Prevalence of asthma and respiratory symptoms according to diabetes or not METHODS A postal questionnaire was sent to population based samples in Denmark, Estonia, Iceland, Norway and Sweden participating in RHINE (Respiratory Health In Northern Europe) in 1999-2001. 16190 subjects aged 25 to 56 years responded (77 %). Analyses included 13568 persons with complete data, of which 231 (1.43 %) reported diabetes. Logistic regressions with adjustments for smoking, BMI, age, centre and social class were performed. * Diabetes defined as answering yes to the question “Has any doctor ever told you that you have diabetes?” **For continuous variables: Kruskal-Wallis equality-of-populations rank test TABLE 3. Associations of diabetes with asthma, respiratory symptoms and allergy, as compared with persons not reporting diabetes no diabetes ( n=13568) diabetes* (n=231) % OR (95 % CI)* p-value Asthma† 6.7 10.1 1.63 (1.05-2.54) 0.03 Wheeze‡ 20 35 1.77 (1.32-2.37) 0.00 ≥3 Respiratory symptoms§ 14 28 1.58 (1.14-2.19) Chronic bronchitis** 31 37 0.80 (0.425-1.51) 0.5 Hay fever†† 23 27 1.34 (0.99-1.81) 0.06 Allergic asthma‡‡ 4.3 5.2 1.33 (0.73-2.04) 0.35 TABLE 1. Characteristics of 16190 persons aged 25 to 55 years in 7 north European centres Centre study population median age women / men median BMI current smokers diabetes* asthma† hay fever‡ ≥3 respiratory symptoms§ n years %/% kg/m2 % n (%) Aarhus 2607 39 48/52 23.7 35 6 (1.63) 6.4 22 13 Reykjavik 1969 41 45/55 24.8 31 18 (0.93) 21 11 Bergen 2506 40 24.2 43 (1.74) 6.3 24 16 Gothenburg 2188 46/54 24.5 30 43 (1.99) 7.3 26 Umeå 2640 49/51 24.7 19 53 (2.02) 9.2 23 15 Uppsala 2572 47/53 24.1 20 43 (1.69) 7.5 25 Tartu 1708 44/56 23.4 25 (1.48) 2.1 Total 16190 29 231 (1.43) 6.7 23.2 14.4 CONCLUSION Diabetes is associated with asthma and asthma symptoms. The findings support the hypothesis of a metabolic component in asthma. REFERENCES *From logistic regression models with adjustment for smoking, BMI, age, centre and social class (dwelling) †Asthma medication and/or asthma attacks last 12 months ‡Wheeze in the last 12 months §Symptoms included: wheeze, wheeze with shortness of breath, wheeze without cold, waking with tightness in chest, waking with shortness of breath, waking with cough, asthma attacks, current asthma medication ** Answering yes to the questions “Do you cough up phlegm in this way almost every day for at least three months every year?” and “Have you had periods of this kind for at least two years in a row?” ††Hay fever or nasal allergies ‡‡Asthma and hay fever Printed by 1. Shore SA. Obesity and asthma: possible mechanisms. J Allergy Clin Immunol 2008;121(5):1087-93; quiz 1094-5. 2. Alves C, Diniz AB, Souza MB, Ponte EV, Araujo MI. [Controversies in the association between type 1 diabetes and asthma]. Arq Bras Endocrinol Metabol 2007;51(6):930-7. 3. Bjornvold M, Munthe-Kaas MC, Egeland T, Joner G, Dahl-Jorgensen K, Njolstad PR, et al. A TLR2 polymorphism is associated with type 1 diabetes and allergic asthma. Genes Immun 2009. * Diabetes defined as answering yes to the question “Has any doctor ever told you that you have diabetes?” † Asthma defined as current asthma medication and/or asthma attacks last 12 months ‡ Hay fever defined as current hay fever or nasal allergies § Symptoms included: wheeze, wheeze with shortness of breath, wheeze without cold, waking with tightness in chest, waking with shortness of breath, waking with cough, asthma attacks, current asthma medication