Evolution of body mass index in children with type 1 diabetes mellitus

Abstract

The prevalence of childhood overweight and obesity has risen during the last 30 years, not only in children with type 2 diabetes, but also those with type 1 (T1D) and this is linked with an increased cardiovascular risk. A better understanding of weight patterns in the years after diagnosis of T1D is important to identify those children with a risk for excess weight gain and strategies to decrease this. We retrospectively analyzed data of all children with T1D followed at the department of Pediatric Endocrinology Leuven and diagnosed between 1991 and 2015. Data as age, sex, BMI, and Tanner score were extracted in 390 subjects. Standardized BMI (BMI SDS) in this study group using all data was 0.26. An increase in BMI SDS was seen as a function of time since diagnosis and age, both being independent predictors. Data comparison showed a significant stronger relation between BMI SDS and both time since diagnosis and age in girls. Children diagnosed after puberty showed a higher increase in BMI SDS.Conclusion: These longitudinal data suggest an important increase in BMI in children with T1D, both as a function of time since diagnosis and age, especially in girls. What is Known: • The prevalence of childhood overweight and obesity is risen during the last 30 years, in children with type 2 diabetes, but also those with type 1 diabetes. What is New: • Our study demonstrates with longitudinal data an increase in BMI in children with type 1 diabetes, especially girls. The increase in BMI SDS is seen as a function of time since diagnosis and age, both being independent predictors. Given the increased risk of metabolic syndrome and other complications in overweight children, special attention is needed to prevent this evolution.

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

“…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.…”

Double diabetes: A distinct high‐risk group?

“…The latter can interact with T1D duration, making DD a time‐dependent condition. Even those with initial good insulin sensitivity and no genetic predisposition may transition to DD secondary to unhealthy lifestyle that leads to weight gain . While genetic predisposition is non‐modifiable, environmental factors can be controlled, thus limiting the prevalence of DD.…”

“…Even those with initial good insulin sensitivity and no genetic predisposition may transition to DD secondary to unhealthy lifestyle that leads to weight gain. 47 While genetic predisposition is non-modifiable, environmental factors can be controlled, thus limiting the prevalence of DD. Exposure to obesogenic environments affects the rate of overweight and obesity, particularly among children.…”

MECHANISMS OF ENDOCRINOLOGY: Mechanisms of disease: the endocrinology of obstructive sleep apnoea

“…However, there is increasing interest in OSA in patients with T1D, particularly that some recent studies suggest that OSA in T1D might be more related to autonomic neuropathy rather than obesity (158). In addition, epidemiological studies suggest that obesity prevalence is increasing in patients with T1D which might further increase their risk of developing OSA (159).…”

“…IH, intermittent hypoxia; RAAS, renin-angiotensin-aldosterone system; RH, resistant hypertension; PA, primary aldosteronism; MR, mineralocorticoid receptors. In rodent studies, IH promoted angiotensin I and AT1 expression, increased the activation of the carotid body by angiotensin II and resulted in increased renin and aldosterone levels leading to increased BP (159,169,170). In addition, oxidative stress has been shown to increase the activation of the mineralocorticoid receptors (MR) in rodent models (171).…”