Showing papers in "Pediatric Diabetes in 2018"
TL;DR: Recommendations concerning fluid management have been modified to reflect recent findings from a randomized controlled clinical trial showing no difference in cerebral injury in patients rehydrated at different rates with either 0.45% or 0.9% saline.
Abstract: Recommendations concerning fluid management have been modified to reflect recent findings from a randomized controlled clinical trial showing no difference in cerebral injury in patients rehydrated at different rates with either 0.45% or 0.9% saline. This article is protected by copyright. All rights reserved.
480 citations
TL;DR: A marked elevation of the BGL confirms the diagnosis of diabetes, including a random plasma glucose concentration ≥11.1 mmol/L (200 mg/dl) or fasting plasma glucose ≥7.0 mmol/l (≥126 mg/DL) in the presence of overt symptoms.
Abstract: Diagnostic criteria for all types of diabetes in children and adolescents are based on laboratory measurement of plasma glucose levels (BGL) and the presence or absence of symptoms (E). Finger prick BGL testing should not be used to diagnose diabetes (E). A marked elevation of the BGL confirms the diagnosis of diabetes, including a random plasma glucose concentration ≥11.1 mmol/L (200 mg/dl) or fasting plasma glucose ≥7.0 mmol/l (≥126 mg/dl) in the presence of overt symptoms. This article is protected by copyright. All rights reserved.
389 citations
378 citations
TL;DR: Clinically evident diabetes-related vascular complications are rare in childhood and adolescence, however, early functional and structural abnormalities may be present a few years after the onset of the disease.
Abstract: Clinically evident diabetes-related vascular complications are rare in childhood and adolescence. However, early functional and structural abnormalities may be present a few years after the onset of the disease. This article is protected by copyright. All rights reserved.
247 citations
University of Exeter1, University of Chicago2, Paris Descartes University3, Haukeland University Hospital4, University of Bergen5, Medical University of Łódź6, Lund University7, Charité8, Boston Children's Hospital9, Hanoi Medical University10, Children's Hospital at Westmead11, University of New South Wales12
TL;DR: Well over 40 different genetic subtypes of monogenic diabetes have been identified to date, each having a typical phenotype and a specific pattern of inheritance.
Abstract: Monogenic diabetes results from one or more defects in a single gene. The disease may be inherited within families as a dominant, recessive or non-Mendelian trait or may present as a spontaneous case due to a de novo mutation (i.e. not inherited from parents). Well over 40 different genetic subtypes of monogenic diabetes have been identified to date, each having a typical phenotype and a specific pattern of inheritance. This article is protected by copyright. All rights reserved.
235 citations
TL;DR: The main findings from studies of psychological adjustment, psychiatric disorders, neurocognitive and educational functioning, family dynamics, social support, stress and coping, quality of life, and behavioral interventions in children and adolescents with T1D are reviewed.
Abstract: A substantial research base developed over the past thirty years provides evidence for the significant role of psychosocial factors in the management of type 1 diabetes (T1D) in children and adolescents (3-7). We review the main findings from studies of psychological adjustment, psychiatric disorders, neurocognitive and educational functioning, family dynamics, social support, stress and coping, quality of life, and behavioral interventions in children and adolescents with T1D. This article is protected by copyright. All rights reserved.
186 citations
TL;DR: The 2018 ISPAD Guidelines have been updated based on published data and evolving expert opinion since the 2014 chapter was published, including treatment target (HbA1c=7%) and intensification of management recommendations.
Abstract: The 2018 ISPAD Guidelines have been updated based on published data and evolving expert opinion since the 2014 chapter was published, including treatment target (HbA1c=7%) and intensification of management recommendations. This article is protected by copyright. All rights reserved.
168 citations
TL;DR: To assess the change in rates of pediatric real‐time or intermittent scanning continuous glucose monitoring (CGM) use over the past 5 years, and how it impacts glycemic control, data from two registries were compared.
Abstract: BACKGROUND To assess the change in rates of pediatric real-time or intermittent scanning continuous glucose monitoring (CGM) use over the past 5 years, and how it impacts glycemic control, data from two registries were compared: the US-based type 1 diabetes Exchange Registry (T1DX) and the German/Austrian DPV (Prospective Diabetes Follow-Up Registry). METHODS Registry participants aged <18 years with T1D duration ≥1 year encompassed 29 007 individuals in 2011 and 29 150 participants in 2016. Demographic data, CGM use and hemoglobin A1c (HbA1c) were obtained from medical records. RESULTS CGM use increased from 2011 to 2016 in both registries across all age groups, regardless of gender, ethnic minority status or insulin delivery method. The increase in CGM use was most pronounced in the youngest patients, and usage rates remain lowest for adolescent patients in 2016. For both registries in 2016, mean HbA1c was lower among CGM users regardless of insulin delivery method compared to pump only (P < 0.001) and injection only (P < 0.001), and CGM users were more likely to achieve glycemic target of HbA1c <7.5% (56% vs 43% for DPV and 30% vs 15% for T1DX, P < 0.001). T1DX participants had a higher mean HbA1c compared with DPV despite whether they were CGM users or non-users; however, the difference was less pronounced in CGM users (P < 0.001). CONCLUSIONS Pediatric CGM use increased in both registries and was associated with lower mean HbA1c regardless of insulin delivery modality.
167 citations
TL;DR: The ISPAD Hypoglycemia guidelines have been harmonized with the International HypoglyCEmia Study Group (IHSG) and are suitable for use in combination with conventional diabetes care.
Abstract: The ISPAD Hypoglycemia guidelines have been harmonized with the International Hypoglycemia Study Group (IHSG). This article is protected by copyright. All rights reserved.
166 citations
TL;DR: Refined recommendations on intensive regimens for differential substitution of basal and prandial insulin are made and the role of new insulin analogs, biosimilars and devices are reviewed.
Abstract: Refined recommendations on intensive regimens for differential substitution of basal and prandial insulin. Review of the role of new insulin analogs, biosimilars and devices for insulin therapy in pediatric diabetology are included. This article is protected by copyright. All rights reserved.
159 citations
TL;DR: Advances in insulin formulations and their delivery include rapid acting and basal insulins as well as insulin pumps to more effectively dose insulin.
Abstract: Numerous milestones mark the advance of diabetes care since the discovery of insulin in 1921. Glucose monitoring has progressed from urine to blood to interstitial fluid measurements every 5-15 minutes with continuous glucose monitors (CGM). Similarly, advances in insulin formulations and their delivery include rapid acting and basal insulins as well as insulin pumps to more effectively dose insulin. This article is protected by copyright. All rights reserved.
TL;DR: Although there is strong evidence for nutritional requirements in young people the scientific evidence base for many aspects of diabetes dietary management is still emerging and it is important to individualize nutrition interventions and meal plans.
Abstract: Nutritional management is one of the cornerstones of diabetes care and education. Different countries and regions have widely varying cultures and socio- economic status that influence and dominate dietary habits. Although there is strong evidence for nutritional requirements in young people the scientific evidence base for many aspects of diabetes dietary management is still emerging and it is important to individualize nutrition interventions and meal plans. This article is protected by copyright. All rights reserved.
TL;DR: The influence of HLA and non‐HLA genes on T1D risk and disease progression through the preclinical stages of the disease, and the development of genetic scores that can be applied to disease prediction are discussed.
Abstract: Type 1 diabetes (T1D) results from immune-mediated loss of pancreatic beta cells leading to insulin deficiency. It is the most common form of diabetes in children, and its incidence is on the rise. This article reviews the current knowledge on the genetics of T1D. In particular, we discuss the influence of HLA and non-HLA genes on T1D risk and disease progression through the preclinical stages of the disease, and the development of genetic scores that can be applied to disease prediction. Racial/ethnic differences, challenges and future directions in the genetics of T1D are also discussed.
TL;DR: In the field of technology, intermittent scanning continuous glucose monitoring (isCGM) offers the opportunity to obtain glucose values more easily than with self-monitored blood glucose monitoring as mentioned in this paper.
Abstract: In the field of technology, intermittent scanning continuous glucose monitoring (isCGM) offers the opportunity to obtain glucose values more easily than with self-monitored blood glucose monitoring (SMBG). This technology also provides the user with information on the direction and the rate of glucose value changes. However, the individual must actively scan the sensor to receive a value. Alerts or alarms are not currently linked to this technology. This article is protected by copyright. All rights reserved.
TL;DR: There are important pathophysiologic differences between CFRD and type 1 and type 2 diabetes Table 1, which necessitate a unique approach to diagnosis and management.
Abstract: Cystic fibrosis (CF) is the most common lethal genetic autosomal recessive disease in Caucasians, with a worldwide prevalence of 1 in ~2500 live births. Cystic fibrosis related diabetes (CFRD) is the most common co-morbidity in CF. There are important pathophysiologic differences between CFRD and type 1 and type 2 diabetes Table 1, which necessitate a unique approach to diagnosis and management. Factors specific to CF which impact glucose metabolism include the loss of total islets leading to both insulin and glucagon deficiency, chronic and acute inflammation and infection which cause fluctuating insulin resistance, a requirement for high caloric intake because of increased energy expenditure and malabsorption, risk of life-threatening malnutrition, and gut abnormalities including delayed gastric emptying, altered intestinal motility, and liver disease. This article is protected by copyright. All rights reserved.
TL;DR: Pre-conceptional counseling should begin early during puberty and mental health problems that may be associated with poor metabolic control should be treated early in girls, according to a report on diabetes-related technologies.
Abstract: -Pre-conceptional counseling should begin early during puberty -New recommendations for type of contraception that should be used for girls are made. -Transition programs and care for young adults are now included. -Mental health problems that may be associated with poor metabolic control should be treated early. -Adherence remains that greatest impediment to successful deployment of diabetes-related technologies. This article is protected by copyright. All rights reserved.
TL;DR: In this article, the worry scale of the Hypoglycemia Fear Survey modified for parents (HFS-P) was used to measure the level of concern parents have with hypocemia in young children with Type 1 diabetes.
Abstract: Background
Fear of hypoglycemia is common in parents of young children with type 1 diabetes (T1D), but little is known about the specific fears that parents most often experience. Hypoglycemia fear has been associated with poorer glycemic control in older children, though not yet studied in a large cohort of very young children.
Materials and Methods
Parents of 549 children <7 years (mean 5.2 ± 1.2 years [19% <3 years]) with a mean diabetes duration of 2.4 ± 1.0 years (range 1-6 years) and mean HbA1c 8.2% ± 1.1% (66 ± 12 mmol/mol) registered in the T1D Exchange completed the worry scale of the Hypoglycemia Fear Survey modified for parents (HFS-P).
Results
Mean parental fear of hypoglycemia worry score was 36.1 ± 23.1 (possible range 0-100), with most frequent worries related to the child having a low while asleep and the child not recognizing a low. The mean worry score was not associated with the child's age, glycemic control, or recent severe hypoglycemic event. Parental worries about lows while sleeping were significantly higher in pump users than non-users (61% vs. 45%; P < .001), and tended to be higher in CGM users than non-users (62% vs 51%; P = .02).
Conclusions
The greatest worries of parents of young children with T1D were related to hypoglycemia during sleep and other times/circumstances during which it would be difficult to detect hypoglycemia. Using advanced diabetes technologies may be an effort to temper fears about hypoglycemia during sleep, though the directionality of this relationship is undetermined. Additional studies can clarify this association and leverage use of diabetes technologies to improve glycemic control.
TL;DR: The challenge for diabetes health care professionals is to deliver diabetes education that optimizes the families' knowledge and understanding of the condition and its treatment and assists them to adjust to living with diabetes.
Abstract: To maintain intensive glycemic therapy, families perform a multitude of self-management tasks on a daily basis responding to changes in activity, food and physiology. The challenge for diabetes health care professionals is to deliver diabetes education that optimizes the families' knowledge and understanding of the condition and its treatment and assists them to adjust to living with diabetes. This article is protected by copyright. All rights reserved.
TL;DR: In this update, general guidelines on current diabetes technologies, transition from pediatric to adult care, anticipatory guidance, and barriers to care are expanded.
Abstract: In this update, we have expanded general guidelines on current diabetes technologies, transition from pediatric to adult care, anticipatory guidance, and barriers to care. This article is protected by copyright. All rights reserved.
TL;DR: Monitoring of anthropometric measurements and physical development, using age- appropriate standards and taking mid-parental height into account, is a crucial element in the care of children and adolescents with diabetes.
Abstract: Monitoring of anthropometric measurements and physical development, using age- appropriate standards and taking mid-parental height into account, is a crucial element in the care of children and adolescents with diabetes. This article is protected by copyright. All rights reserved.
TL;DR: This trial evaluated use of flash glucose monitoring in children and teenagers with type 1 diabetes in the hope that it will help improve the quality of life and reduce the likelihood of adverse events.
Abstract: BACKGROUND AND OBJECTIVE Outcomes of using flash glucose monitoring have been reported in adults. This trial evaluated use in children and teenagers with type 1 diabetes. METHODS Prospective, single arm, non-inferiority multicenter study to demonstrate equivalence of time in range (TIR [70-180 mg/dL]) by comparing 14-day masked sensor wear (baseline) with self-monitored blood glucose (SMBG) testing to the final 14-days of 8-week open-label system use for diabetes self-management including insulin dosing. RESULTS A total of 76 children and teenagers (46.1% male; age 10.3 ± 4.0 years, type 1 diabetes duration 5.4 ± 3.7 years; mean ± SD) from 10 sites participated. TIR improved significantly by 0.9 ± 2.8 h/d (P = 0.005) vs SMBG baseline. Time in hyperglycemia (>180 mg/dL) reduced by -1.2 ± 3.3 h/d (P = 0.004). HbA1c reduced by -0.4% (-4.4 mmol/mol), from 7.9 ± 1.0% (62.9 ± 11.2 mmol/mol) baseline to 7.5 ± 0.9% (58.5 ± 9.8 mmol/mol) study end (P < 0.0001) with reductions across all age-subgroups (4-6, 7-12 and 13-17 years). Time in hypoglycemia (<70 mg/dL) was unaffected. Throughout the treatment phase system utilization was 91% ± 9; sensor scanning was 12.9 ± 5.7/d with SMBG dropping to 1.6 ± 1.9 from 7.7 ± 2.5/d. Diabetes Treatment Satisfaction Questionnaire "Total Treatment Satisfaction" score improved for parents (P < 0.0001) and teenagers (P < 0.0001). No adverse events (n = 121) were associated with sensor accuracy, 42 participants experienced sensor insertion signs and symptoms. Three participants experienced three mild device-related (sensor wear) symptoms, resolving quickly (without treatment [n = 2], non-prescription antihistamines [n = 1]). CONCLUSIONS Children with diabetes improved glycemic control safely and effectively with short-term flash glucose monitoring compared to use of SMBG in a single arm study.
TL;DR: Individuals with a first degree relative with type 1 diabetes have an approximately 15-fold increased relative life time risk of type 2 diabetes, but at least 85% of children who develop type 1 Diabetes do not have a family history of type1 diabetes.
Abstract: Individuals with a first degree relative with type 1 diabetes have an approximately 15-fold increased relative life time risk of type 1 diabetes1,3,6 . However at least 85% of children who develop type 1 diabetes do not have a family history of type 1 diabetes. This article is protected by copyright. All rights reserved.
TL;DR: To estimate the prevalence of and risk factors for cardiovascular autonomic neuropathy (CAN) in adolescents and young adults with type 1 and type 2 diabetes enrolled in the SEARCH for Diabetes in Youth Study, data are summarized and analyzed.
Abstract: Objective To estimate the prevalence of and risk factors for cardiovascular autonomic neuropathy (CAN) in adolescents and young adults with type 1 and type 2 diabetes enrolled in the SEARCH for Diabetes in Youth Study. Methods The study included 1646 subjects with type 1 diabetes (age 18 ± 4 years, diabetes duration 8 ± 2 years, HbA1c 9.1 ± 1.9%, 76% non-Hispanic Whites) and 252 with type 2 diabetes (age 22 ± 4 years, diabetes duration 8 ± 2 years, HbA1c 9.2 ± 3.0%, 45% non-Hispanic Blacks). Cross-sectional and longitudinal risk factors were assessed at baseline and follow-up visits. Area under the curve (AUC) was used to assess the longitudinal glycemic exposure and cardiovascular risk factors. CAN was assessed by time and frequency domain indices of heart rate variability (HRV). CAN was defined as the presence of ≥3 of 5 abnormal HRV indices. Results The prevalence of CAN was 12% in adolescents and young adults with type 1 diabetes and 17% in those with type 2 diabetes. Poor long-term glycemic control (AUC HbA1c), high blood pressure, and elevated triglyceride levels were correlates of CAN in subjects with type 1 diabetes. In those with type 2 diabetes, CAN was associated with elevated triglycerides and increased urinary albumin excretion. Conclusions The prevalence of CAN in this multiethnic cohort of adolescents and young adults with type 1 and type 2 diabetes are comparable to those reported in adults with diabetes. Suboptimal glycemic control and elevated triglycerides were the modifiable risk factors associated with CAN.
TL;DR: The prevalence and characteristics of different types of dermatological complications related to continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) are examined.
Abstract: Background Dermatological complications in children and adolescents that are related to continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) have not been well-characterized. This study examined the prevalence and characteristics of different types of dermatological complications. Methods Online questionnaires regarding dermatological complications related to CSII and/or CGM were returned from a total of 144 children and adolescents, aged 2 to 20 years. Both previous and current skin problems were reported along with their clinical characteristics. Descriptive statistics, χ2 tests, and multivariate analyses were used to evaluate the data. Results Of 143 patients using CSII, 90% had previous and 63% reported current dermatological complications. Non-specific eczema was most frequently reported and was currently present in 25.7% of the patients. These results were independent of age and current CGM use. Among the 76 patients using CGM, 46% reported current dermatological complications. A history of atopy was associated with dermatological complications in individuals using CSII, but not CGM. The patients rated CGM-related dermal issues as significantly worse than those associated with CSII (P Conclusions Dermatological complications can be a serious problem in treating pediatric and adolescent patients of all ages with CSII and/or CGM. Only a few clinical characteristics associated with these complications were identified in this study, highlighting the need for prospective studies that might lead to improvements in the prevention and treatment of dermatological problems.
TL;DR: Research among adults suggests diabetes distress is a stronger predictor of HbA1c than depressive symptoms, and some research among adolescents indicates depressive symptoms are associated with suboptimal Hb a1c.
Abstract: BACKGROUND: Glycated hemoglobin (HbA1c) is higher during adolescence than at any other life stage Some research among adolescents indicates that depressive symptoms are associated with suboptimal HbA1c However, research among adults suggests diabetes distress is a stronger predictor of HbA1c than depressive symptoms OBJECTIVE: To determine the relative contributions of depressive symptoms and diabetes distress to explain the variance in HbA1c among adolescents with type 1 diabetes PARTICIPANTS AND METHODS: Diabetes MILES Youth Study respondents aged 13 to 19 years completed questionnaires assessing depressive symptoms (Patient Health Questionnaire for Adolescents: PHQA-8), diabetes distress (Problem Areas in Diabetes-Teen version: PAID-T), and self-reported socio-demographic and clinical variables, including their most recent HbA1c Stepwise hierarchical multiple regression was conducted to examine the contributions of depressive symptoms and diabetes distress to HbA1c RESULTS: Participants (N = 450) had a (mean ± SD) age of 157 ± 19 years; diabetes duration of 69 ± 43 years; and 38% (n = 169) were male Twenty-one percent (n = 96) experienced moderate-to-severe depressive symptoms (PHQA-8 ≥ 11) and 36% (n = 162) experienced high diabetes distress (PAID-T > 90) In the final regression model, HbA1c was explained by: diabetes duration (β = 14, P = 001), self-monitoring of blood glucose (β = -20, P < 001), and diabetes distress (β = 30, P < 001) Following the addition of diabetes distress, depressive symptoms were no longer significantly associated with HbA1c (P = 551) The final model explained 18% of the variance in HbA1c CONCLUSIONS: Consistent with evidence from studies among adults, diabetes distress mediated the relationship between depressive symptoms and HbA1c among adolescents with type 1 diabetes These findings suggest that clinicians need to be aware of diabetes distress
TL;DR: This work investigated the effect of carnosine as an adjuvant therapy on urinary albumin excretion, the tubular damage marker alpha 1‐microglobulin (A1M), and oxidative stress in pediatric patients with type 1 diabetes and nephropathy.
Abstract: Background and Objectives
Oxidative stress is a significant contributor to the pathogenesis of diabetic nephropathy. Carnosine is a natural radical oxygen species scavenger. We investigated the effect of carnosine as an adjuvant therapy on urinary albumin excretion (UAE), the tubular damage marker alpha 1-microglobulin (A1M), and oxidative stress in pediatric patients with type 1 diabetes and nephropathy.
Methods
This randomized placebo-controlled trial included 90 patients with diabetic nephropathy, despite oral angiotensin-converting enzyme inhibitors (ACE-Is), who were randomly assigned to receive either 12 weeks of carnosine 1 g/day (n = 45), or matching placebo (n = 45). Both groups were followed-up with assessment of hemoglobin A1c (HbA1c), UAE, A1M, total antioxidant capacity (TAC) and malondialdhyde (MDA).
Results
Baseline clinical and laboratory parameters were consistent between carnosine and placebo groups (P > .05). After 12 weeks, carnosine treatment resulted in significant decrease of HbA1c (8.2 ± 2.1% vs 7.4 ± 1.3%), UAE (91.7 vs 38.5 mg/g creatinine), A1M (16.5 ± 6.8 mg/L vs 9.3 ± 6.6 mg/L), MDA levels (25.5 ± 8.1 vs 18.2 ± 7.7 nmol/mL) while TAC levels were increased compared with baseline levels (P < .001) and compared with placebo (P < .001). No adverse reactions due to carnosine supplementation were reported. Baseline TAC was inversely correlated to HbA1c (r = −0.58, P = .04) and A1M (r = −0.682, P = .015) among carnosine group.
Conclusions
Oral supplementation with L-Carnosine for 12 weeks resulted in a significant improvement of oxidative stress, glycemic control and renal function. Thus, carnosine could be a safe and effective strategy for treatment of pediatric patients with diabetic nephropathy.
TL;DR: The objective of this study was to describe trends in the incidence and prevalence of type 1 diabetes in a sample of Canadian children and youth.
Abstract: Background and Objective
Incidence rates of type 1 diabetes have long been on the rise across the globe, however, there is emerging evidence that the rate of rise may be slowing. The objective of this study was to describe trends in the incidence and prevalence of type 1 diabetes in a sample of Canadian children and youth.
Methods
Cases were extracted using linked administrative datasets and a validated diabetes case-finding definition. Incidence and prevalence trends were analyzed using the JoinPoint regression analysis program.
Results
A small increase in the incidence of type 1 diabetes was observed over the 11-year period from 2002-2003 to 2012-2013. Total incident cases per year ranged from 201 (2005-2006) to 250 (2007-2008). Total prevalent cases per year ranged from 1790 (2002-2003) to 2264 (2012-2013). Incidence was highest among children aged 5 to 14 years, and lowest in the youngest (1-4 years) and oldest (15-19 years) age brackets. The most significant increase in incidence was in children aged 10 to 14 years. Age-standardized prevalence increased significantly throughout the study period.
Conclusion
These results are similar to data from the United States but differ from European data with respect to the annual percent change for incidence as well as age-specific incidence trends. In keeping with the low mortality rates associated with type 1 diabetes, the prevalence continues to rise.
TL;DR: The average global incidence rates of children newly diagnosed with type 1 diabetes (T1D) is increasing by 3 to 4% per annum, with the greatest increases in incidence rate observed in the those aged under 5 years.
Abstract: ISPAD Clinical Practice Consensus Guidelines 2018 : Management and support of children and adolescents with type 1 diabetes in school
TL;DR: The tried and true "Back to the Future" approach of frequent monitoring of glucose and ketones, preferably of blood over urineketones, with timely administration of supplemental insulin along with 24 hour, 7 day a week access to expert health care team advice can successfully manage sick days and prevent progression to DKA in young persons with insulin treated diabetes.
Abstract: The tried and true \"Back to the Future\" approach of frequent monitoring of glucose and ketones, preferably of blood over urine ketones, with timely administration of supplemental insulin along with 24 hour, 7 day a week access to expert health care team advice can successfully manage sick days and prevent progression to DKA in young persons with insulin treated diabetes. This article is protected by copyright. All rights reserved.
University of Verona1, Aarhus University Hospital2, Sofia Medical University3, University of Ulm4, Boston Children's Hospital5, Katholieke Universiteit Leuven6, Jawaharlal Nehru Medical College, Aligarh7, Sahlgrenska University Hospital8, Semmelweis University9, Centre Hospitalier de Luxembourg10, Copenhagen University Hospital11, Alberta Children's Hospital12, National and Kapodistrian University of Athens13, Tel Aviv University14, University of Gothenburg15, University of Colorado Boulder16
TL;DR: To assess the prevalence of underweight (UW), overweight (OW), and obesity in children and adolescents with type 1 diabetes (T1D), a large number of patients are diagnosed with T1D.
Abstract: OBJECTIVE To assess the prevalence of underweight (UW), overweight (OW), and obesity in children and adolescents with type 1 diabetes (T1D) METHODS An international cross-sectional study including 23 026 T1D children (2-18 years, duration of diabetes ≥1 year) participating in the SWEET prospective, multicenter diabetes registry Body mass index SD score (BMI-SDS) was calculated using the World Health Organization BMI charts Children were categorized as UW (BMI-SDS +2SD) Hierarchic regression models were applied with adjustment for sex, age, and duration of diabetes RESULTS The prevalence of UW, OW, and obesity was: 14%, 223%, and 73% in males and 06%, 272%, and 68% in females Adjusted BMI-SDS was significantly higher in females than in males (mean ± SEM: 054 ± 005 vs 040 ± 005, P < 00001) In males, BMI-SDS significantly decreased by age (P < 00001) in the first three age categories 061 ± 006 (2 to <10 years), 047 ± 006 (10 to <13 years), 034 ± 005 (13 to <16 years) In females, BMI-SDS showed a U-shaped distribution by age (P < 00001): 054 ± 004 (2 to <10 years), 039 ± 004 (10 to <13 years), 055 ± 004 (13 to <16 years) BMI-SDS increased by diabetes duration (<2 years: 038 ± 005, 2 to <5 years: 044 ± 005, and ≥5 years: 050 ± 005, P < 00001) Treatment modality did not affect BMI-SDS Adjusted HbA1c was significantly higher in females than in males (820% ± 010% vs 806% ± 010%, P < 00001) In both genders, the association between HbA1c and BMI-SDS was U-shaped with the highest HbA1c in the UW and obesity groups CONCLUSIONS The high rate of OW and obesity (318%) emphasize the need for developing further strategies to prevent and treat excess fat accumulation in T1D