Association of Insulin Regimen and Estimated Body Fat Over Time among Youths and Young Adults with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

Abstract

Aims. To explore how changes in insulin regimen are associated with estimated adiposity over time among youths and young adults with type 1 diabetes and whether any associations differ according to sex. Materials and Methods. Longitudinal data were analyzed from youths and young adults with type 1 diabetes in the SEARCH for Diabetes in Youth study. Participants were classified according to insulin regimen categorized as exclusive pump (“pump only”), exclusive injections (“injections only”), injection-pump transition (“injections-pump”), or pump-injection transition (“pump-injections”) for each follow-up visit completed. Estimated body fat percentage (eBFP) was calculated using validated equations. Sex-specific, linear mixed effects models examined the relationship between the insulin regimen group and change in eBFP during follow-up, adjusted for baseline eBFP, baseline insulin regimen, time-varying insulin dose, sociodemographic factors, and baseline HbA1c (≥9.0% vs. <9.0%). Results. The final sample included 284 females and 304 males, of whom 80% were non-Hispanic white with mean diagnosis age of 12.7 ± 2.4 years. In fully adjusted models for females, exclusive pump use over the study duration was associated with significantly greater increases in eBFP compared to exclusive use of injections ( difference in rate of change = 0.023 % increase per month, 95 % CI = 0.01 , 0.04). Injection-to-pump transitions and pump-to-injection transitions were also associated with greater increases in eBFP compared to exclusive use of injections ( difference in rate of change = 0.02 % , 95 % CI = 0.004 , 0.03, and 0.02%; 95 % CI = 0.0001 , 0.04, respectively). There was no relationship between the insulin regimen and eBFP among males. Conclusions. Among females with type 1 diabetes, exclusive and partial pump use may have the unintended consequence of increasing adiposity over time compared to exclusive use of injections, independent of insulin dose.

Evaluation of Psychological Resources of Young Adults With Type 1 Diabetes Mellitus During the Transition From Pediatric to Adult Diabetes Clinics: Multicenter Cross-sectional Study

“…It has been shown that insulin pump treatment may be associated with behavior change and less hypoglycemia in comparison to MDIs [ 43 , 44 ]. One may wonder if this mode of treatment also influences the psychological resources.…”

The Influence of Body Fat and Lean Mass on HbA1c and Lipid Profile in Children and Adolescents with Type 1 Diabetes Mellitus

“…Although intensive insulin therapy is crucial for glycemic control, it can also contribute to weight gain, primarily if performed improperly and with excessive calorie intake [ 17 , 18 ].…”