Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: Data from the international SWEET registry

Maffeis, Claudio; Birkebæk, Niels H; Константинова, М. М.; Schwandt, Anke; Vazeou, Andriani; Casteels, Kristina; Jali, Sujata; Limbert, Catarina; Pundziūtė-Lycka, Austė; Tóth-Heyn, Péter; Beaufort, Carine de; Šumnı́k, Zdenĕk; Cherubini, Valentino; Svensson, Jannet; Pacaud, Danièle; Kanaka‐Gantenbein, Christina; Shalitin, Shlomit; Bratina, Nataša; Hanås, Ragnar; Alonso, G. Todd; Poran, Luxmi; Pereira, Ana Lúcia Bender; Marigliano, Marco

doi:10.1111/pedi.12730

Cited by 71 publications

(77 citation statements)

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“…Examination of the latter two subgroups reveals that while overweight and poor glycemic control can co-occur in young people with diabetes (ie, the weight-glycemia phenotype of cluster 5, comprising 8% of the sample), obesity is not always associated and does not necessarily account for those with poor or very poor glycemic control (ie, the weight-glycemia phenotype of cluster 6, comprising 15% of the sample). This is consistent with previous work demonstrating a U-shaped association between HbA1c and BMI standard deviation score (SDS), with the highest HbA1c levels among children and adolescents with T1D who were classified as underweight and obese 8…”

Section: Discussionsupporting

confidence: 92%

“…Given that appropriate treatment algorithms may vary markedly across the broad spectrum of body weight and glycemia,4 the T1D patient population is a good candidate for precision medicine, which matches interventions to different subgroups of patients expected to show a positive response 5 6. Epidemiological evidence suggests population-level associations between body mass index z-score (BMIz) and hemoglobin A1c (HbA1c)2 7 8; however, surprisingly little is known about how weight status and glycemic control are codistributed across the population and interact to form more nuanced clinical phenotypes of T1D. The weight-glycemia phenotype may confer information about goals for treatment and effectiveness of specific therapeutic strategies for optimizing outcomes simultaneously, especially given that weight gain may be an unintended consequence of intensive insulin therapy in some individuals 9…”

Section: Introductionmentioning

confidence: 99%

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Characterizing the weight-glycemia phenotypes of type 1 diabetes in youth and young adulthood

Kahkoska

Nguyen

Jiang

et al. 2020

BMJ Open Diab Res Care

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IntroductionIndividuals with type 1 diabetes (T1D) present with diverse body weight status and degrees of glycemic control, which may warrant different treatment approaches. We sought to identify subgroups sharing phenotypes based on both weight and glycemia and compare characteristics across subgroups.Research design and methodsParticipants with T1D in the SEARCH study cohort (n=1817, 6.0–30.4 years) were seen at a follow-up visit >5 years after diagnosis. Hierarchical agglomerative clustering was used to group participants based on five measures summarizing the joint distribution of body mass index z-score (BMIz) and hemoglobin A1c (HbA1c) which were estimated by reinforcement learning tree predictions from 28 covariates. Interpretation of cluster weight status and glycemic control was based on mean BMIz and HbA1c, respectively.ResultsThe sample was 49.5% female and 55.5% non-Hispanic white (NHW); mean±SD age=17.6±4.5 years, T1D duration=7.8±1.9 years, BMIz=0.61±0.94, and HbA1c=76±21 mmol/mol (9.1±1.9)%. Six weight-glycemia clusters were identified, including four normal weight, one overweight, and one subgroup with obesity. No cluster had a mean HbA1c <58 mmol/mol (7.5%). Cluster 1 (34.0%) was normal weight with the lowest HbA1c and comprised 85% NHW participants with the highest socioeconomic position, insulin pump use, dietary quality, and physical activity. Subgroups with very poor glycemic control (ie, ≥108 mmol/mol (≥12.0%); cluster 4, 4.4%, and cluster 5, 7.5%) and obesity (cluster 6, 15.4%) had a lower proportion of NHW youth, lower socioeconomic position, and reported decreased pump use and poorer health behaviors (overall p<0.01). The overweight subgroup with very poor glycemic control (cluster 5) showed the highest lipids and blood pressure (p<0.01).ConclusionsThere are distinct subgroups of youth and young adults with T1D that share weight-glycemia phenotypes. Subgroups may benefit from tailored interventions addressing differences in clinical care, health behaviors, and underlying health inequity.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Characterizing the weight-glycemia phenotypes of type 1 diabetes in youth and young adulthood

Kahkoska

Nguyen

Jiang

et al. 2020

BMJ Open Diab Res Care

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“…Furthermore, we preferred type‐one errors (ie, false positives) above type‐two errors (ie, false negatives), that way ensuring to detect all group differences. Finally, the majority of the parents were married/cohabiting and were highly educated, and the children with T1D had a mean HbA1c of 7.07%, which is slightly lower than the international average (ie, 7.5%; 0‐10 years) . Consequently, the present sample may represent a selective highly functioning sample, but as no sociodemographic data of families who declined participation were available, a comparison with decliners was not possible.…”

Section: Discussionmentioning

confidence: 95%

Families with pediatric type 1 diabetes: A comparison with the general population on child well‐being, parental distress, and parenting behavior

et al. 2019

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Aims: The aim of this study was to compare families with a child (2-12 years) with type 1 diabetes (T1D) to families which are not confronted with chronic illness, with regard to children's well-being, parental distress, and parenting behavior. In addition, differences were explored between families whose child has optimal vs suboptimal glycemic control.Methods: Mothers, fathers, and children of 105 families with pediatric T1D completed questionnaires assessing child well-being, parental distress, and parenting. The control group consisted of 414 families without chronic illness.Results: With regard to child well-being, children with T1D had more adjustment difficulties (as reported by mothers) and lower quality of life (QoL) (as reported by mothers and fathers), whereas children themselves (8-12 years) reported higher QoL compared to controls. In terms of parental distress, mothers, but not fathers, of children with T1D reported more stress, anxiety symptoms, and depressive symptoms than controls. With regard to parenting behavior, parent reports revealed less protectiveness in fathers and less autonomy support and responsiveness in both parents as compared to controls. No differences were found in parent-reported psychological

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“…The BMI‐SDS was calculated based on WHO growth curves . Participants were divided into the following groups: normal‐low (BMI‐SDS <0); normal‐high [BMI‐SDS 0 to <2 (age <5 years) or 0 to <1 (age ≥5 years)]; overweight [BMI‐SDS 2 to <3 (age <5 years) or 1 to <2 (age ≥5 years)] and obese [BMI‐SDS ≥3 (age <5 years) or ≥2 (age ≥ 5 years)].…”

Section: Participants and Methodsmentioning

confidence: 99%

Lipid profile is associated with treatment regimen in a large cohort of children and adolescents with Type 1 diabetes mellitus: a study from the international SWEET database

et al. 2019

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Aims To examine the effect of pump vs injection therapy on the lipid profile of children with Type 1 diabetes mellitus.Methods A cross-sectional analysis of the lipid profile of children aged ≤ 18 years with Type 1 diabetes mellitus from SWEET, an international diabetes registry, was conducted with a focus on the effect of treatment regimen. Dyslipidaemia was defined as LDL cholesterol ≥2.6 mmol/l or non-HDL cholesterol ≥3.1 mmol/l. LDL and non-HDL cholesterol values among 14 290 children (52% boys, 51% receiving pump therapy) from 60 SWEET centres were analysed by linear and logistic regression analysis adjusted for sex, age, diabetes duration, HbA 1c and BMI-standard deviation score group, region, and common interactions between age, sex, HbA 1c and BMI.Results This study confirmed the established associations of increased lipids with female sex, age, diabetes duration, HbA 1c and BMI. LDL and non-HDL cholesterol levels were lower in the pump therapy group compared to the injection therapy group [LDL cholesterol: injection therapy 2.44 mmol/l (95% CI 2.42 to 2.46) vs pump therapy 2.39 mmol/l (95% CI 2.37-2.41), P<0.001; non-HDL cholesterol: injection therapy 2.88 mmol/l (95% CI 2.86 to 2.90) vs pump therapy 2.80 mmol/l (95% CI 2.78-2.82), both P<0.0001]. Similarly, the odds ratios for LDL cholesterol ≥2.6 mmol/l [0.89 (95% CI 0.82-0.97)] and non-HDL cholesterol ≥3.1 mmol/l [0.85 (0.78 to 0.93)] were significantly lower in the pump therapy group, even after all adjustments. ConclusionsOur results indicate that pump therapy is associated with a better lipid profile.

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Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: Data from the international SWEET registry

Abstract: The high rate of OW and obesity (31.8%) emphasize the need for developing further strategies to prevent and treat excess fat accumulation in T1D.

Cited by 71 publications

References 58 publications

Characterizing the weight-glycemia phenotypes of type 1 diabetes in youth and young adulthood

Characterizing the weight-glycemia phenotypes of type 1 diabetes in youth and young adulthood

Families with pediatric type 1 diabetes: A comparison with the general population on child well‐being, parental distress, and parenting behavior

Lipid profile is associated with treatment regimen in a large cohort of children and adolescents with Type 1 diabetes mellitus: a study from the international SWEET database

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