Body mass index standard deviation score and obesity in children with type 1 diabetes in the Nordic countries. HbA<sub>1c</sub>
 and other predictors of increasing BMISDS

Birkebæk, Niels H; Kahlert, Johnny; Bjarnason, Ragnar; Drivvoll, AK; Johansen, Anders; Konradsdottir, Elisabet; Pundziūtė-Lycka, Austė; Samuelsson, Ulf; Skrivarhaug, Torild; Svensson, Jannet

doi:10.1111/pedi.12693

Cited by 22 publications

(39 citation statements)

References 39 publications

(83 reference statements)

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“…In our study, we found that that girls with T1D had higher BMI Z‐score compared with both boys with T1D and healthy peers. This observation was in concordance with several other studies including a very large study, investigating BMI Z‐score in 11.500 children and adolescents with T1D from Denmark, Iceland, Norway, and Sweden . In our study, BMI Z‐score correlated negatively to CTX Z‐score (and not OCN Z‐score) which could explain why CTX Z‐score was significantly lower in girls compared with boys, as girls had significantly higher BMI Z‐scores compared with the boys with T1D.…”

Section: Discussionsupporting

confidence: 93%

Decreased markers of bone turnover in children and adolescents with type 1 diabetes

et al. 2020

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Background and aim: Adults with type 1 diabetes (T1D) have increased risk of bone fractures and decreased bone mineral density (BMD). Alterations in bone turnover have been suggested as the link between T1D and the impaired bone health. Furthermore, bone turnover has been suggested to have beneficial effects on glucose metabolism. This study aimed at describing bone turnover markers (BTM), and the relationship with glycemic control, in children and adolescents with T1D.Methods: A total of 173 (47% girls) children and adolescents aged 7.7 to 17.5 years with T1D for more than 1 year were included. Participants were evaluated by BMD together with measurements of selected BTM; two formation markers: osteocalcin (OCN) and procollagen type-1 amino-terminal propeptide (P1NP) and one resorption marker, C-terminal cross-linked telopeptide of type-1 collagen (CTX). BTM were converted into Z-scores utilizing new national references.Results: Mean OCN Z-score (−0.68 ± 1.31), P1NP Z-score (−0.33 ± 1.03) and CTX Z-score (−0.43 ± 1.10) were all significantly lower than the reference population (P < .001). No associations were seen between BTM and T1D duration. BMD Z-score was comparable to the reference population and associated with none of individual BTMs. CTX Z-score was negatively associated with HbA1c (P = .007) independent of both exogenous and residual endogenous insulin.Conclusions: Markers of bone formation and resorption were decreased in children and adolescents with T1D. CTX Z-score associated negatively with HbA1c adjusted for insulin treatment and endogenous insulin production indicating a potential

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Section: Discussionsupporting

confidence: 93%

Decreased markers of bone turnover in children and adolescents with type 1 diabetes

et al. 2020

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“…Enhanced metabolic control to lower HbA 1c often improves hyperlipidaemia which benefits cardiovascular health 8 . However, optimizing treatment in order to lower HbA 1c levels has been suspected to be related to increased BMI and obesity, 9,10 with a possible negative effect on cardiovascular health 11,12 . In general, the effects of increased childhood BMI on cardiovascular outcomes later in life might, to some extent, be mediated through adult BMI 13 .…”

Section: Introductionmentioning

confidence: 99%

Association between glycaemic outcome and BMI in Danish children with type 1 diabetes in 2000–2018: a nationwide population‐based study

et al. 2020

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Aim To describe the development of HbA1c and BMI over time in Danish children with type 1 diabetes; and to investigate the association between HbA1c and BMI including influence of age, gender, diabetes duration, severe hypoglycaemia and treatment method. Methods We used the nationwide Danish Registry of Childhood and Adolescent Diabetes, DanDiabKids, including annual registrations of all children with diabetes treated at Danish hospitals. With linear mixed‐effects models and splines we analyzed the HbA1c and BMI development over time as well as the association between HbA1c and BMI including effects of gender, age, disease duration, hypoglycaemia and treatment method. BMI z‐scores were calculated for these analyses. Results For the period from 2000 to 2018, 6097 children with type 1 diabetes were identified from the DanDiabKids database. The median (interquartile range) HbA1c level was 65 (57–74) mmol/mol (8.1%) and the median BMI z‐score was 0.85 in girls and 0.67 in boys. A non‐linear association was found between HbA1c and BMI z‐score, with the highest BMI z‐score observed for HbA1c values in the range of approximately 60–70 mmol/mol (7.6–6.8%). The association was modified by gender, age and diabetes duration. Severe hypoglycaemia and insulin pump treatment had a small positive impact on BMI z‐score. Conclusion The association between HbA1c and BMI z‐score was non‐linear, with the highest BMI z‐score being observed for intermediate HbA1c levels; however, specific patterns depended on gender, age and diabetes duration.

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“…As known anabolic effects of insulin, and by using intensive insulin regimen, excessive weight gain and obesity are another common problem in children with T1DM. Increased BMI in youth with T1DM has been reported in clinic-based and national cohorts and is associated with a more atherogenic cardiovascular disease risk profile [33,34]. In a retrospective study from Australia 20-year follow-up of 1975 children with type 1 diabetes, the proportion of overweight and obese children was higher than that in the general Australian pediatric population [35].…”

Section: Discussionmentioning

confidence: 94%

Treatment and long-term follow-up of patients diagnosed with type 1 diabetes mellitus before age 5

Ata

Evin

et al. 2020

Journal of Pediatric Endocrinology and Metabolism

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ObjectivesThis study aimed to determine the effects of continuous subcutaneous insulin infusion (CSII) treatment on anthropometric measurements, mean HbA1c, and insulin dosage in patients diagnosed under 5 years of age and compare with multiple-dose injection therapy (MDI).MethodsChildren with type 1 diabetes mellitus, diagnosed <5 years since 2000 and their 19-year follow-up were evaluated retrospectively. Weight, height, body mass index (BMI), blood pressure, and HbA1c values were recorded for each visit.ResultsHundred and five patients (58.1% female, 41.9% male) were included in the study. Sixty-three (60 %) patients were treated by CSII and 42 (40%) by MDI. Mean age at diagnosis was 2.68 ± 1.42 and 3.29 ± 1.30 years respectively. Mean follow-up was 7.42 ± 4.76 and 6.01 ± 4.41 years respectively. For each group, weight standard deviation score (SDS) increased significantly in the first year after the diagnosis (p<0.001), and with the onset of puberty weight SDS decreased significantly (p<0.001). The trend of weight and BMI SDS changes over the years showed similar characteristics in both groups. During follow-up height SDS was similar in both groups except in Tanner stage 5. When puberty was completed, mean height SDS was 0.51 ± 1.03 in CSII and −0.31 ± 0.75 in the MDI group (p: 0.029). Mean HbA1c was significantly lower in the CSII group (7.62 ± 0.82 and 8.17 ± 1.22 respectively). Systolic and diastolic blood pressure change trends during the follow-up were also similar in both groups.ConclusionsCSII treatment had positive effects on metabolic control and height SDS in patients with early-onset diabetes without increasing BMI.

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Body mass index standard deviation score and obesity in children with type 1 diabetes in the Nordic countries. HbA_1c and other predictors of increasing BMISDS

Cited by 22 publications

References 39 publications

Decreased markers of bone turnover in children and adolescents with type 1 diabetes

Decreased markers of bone turnover in children and adolescents with type 1 diabetes

Association between glycaemic outcome and BMI in Danish children with type 1 diabetes in 2000–2018: a nationwide population‐based study

Treatment and long-term follow-up of patients diagnosed with type 1 diabetes mellitus before age 5

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Body mass index standard deviation score and obesity in children with type 1 diabetes in the Nordic countries. HbA1c and other predictors of increasing BMISDS

Cited by 22 publications

References 39 publications

Decreased markers of bone turnover in children and adolescents with type 1 diabetes

Decreased markers of bone turnover in children and adolescents with type 1 diabetes

Association between glycaemic outcome and BMI in Danish children with type 1 diabetes in 2000–2018: a nationwide population‐based study

Treatment and long-term follow-up of patients diagnosed with type 1 diabetes mellitus before age 5

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Body mass index standard deviation score and obesity in children with type 1 diabetes in the Nordic countries. HbA_1c and other predictors of increasing BMISDS