N H Birkebaek1, J Kahlert2, R Bjarnason3, A K Drivvoll4, A Johansen5, E Konradsdottir6, A Pundziute-Lyckå7, U Samuelsson8, T Skrivarhaug4, J Svensson9. 1. Department of Paediatrics, Aarhus University Hospital, Aarhus University, Aarhus, Denmark. 2. Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. 3. Landspitali University Hospital, and Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 4. Division of Paediatrics and Adolescent Medicine, Oslo University Hospital, Oslo, Norway. 5. Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark. 6. Landspitali University Hospital, and School of Health Sciences, University of Iceland, Reykjavik, Iceland. 7. Queen Silvia Children's Hospital, Gothenburg, Sweden. 8. Department of Pediatrics, Linköbing University Hospital, Linköping, Sweden. 9. Department of Paediatrics, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark.
Abstract
BACKGROUND: Intensified insulin therapy may increase body weight and cause obesity. This study compared body mass index standard deviation score (BMISDS) and obesity rate in children with type 1 diabetes (T1D) in Denmark, Iceland, Norway and Sweden, and uncovered predictors for increasing BMISDS. METHODS: Data registered in the Nordic national childhood diabetes databases during the period 2008-2012 on children below 15 years with T1D for more than 3 months were compiled, including information on gender, age, diabetes duration, hemoglobin A1c (HbA1c ), insulin dose, severe hypoglycemia (SH), treatment modality, height and weight. The Swedish reference chart for BMI was used for calculating BMISDS. RESULTS: Totally, 11 025 children (48% females) (30 994 registrations) were included. Medians by the last recorded examination were: age, 13.5 years; diabetes duration, 4.3 years; HbA1c , 7.9% (63 mmol/mol); insulin dose, 0.8 IU/kg/d and BMISDS, 0.70. Obesity rate was 18.5%. Adjusted mean BMISDS (BMISDS adj) was inversely related to HbA1c and directly to diabetes duration. Higher BMISDS adj was found in those with an insulin dose above 0.6 IU/kg/d, and in girls above 10 years. Pump users had higher BMISDS adj than pen users, and patients with registered SH had higher BMISDS adj than patients without SH (both P < .001). CONCLUSION: Obesity rate in children with T1D in the Nordic countries is high, however, with country differences. Low HbA1c , long diabetes duration, higher insulin dose, pump treatment and experiencing a SH predicted higher BMISDS. Diabetes caregivers should balance the risk of obesity and the benefit of a very low HbA1c.
BACKGROUND: Intensified insulin therapy may increase body weight and cause obesity. This study compared body mass index standard deviation score (BMISDS) and obesity rate in children with type 1 diabetes (T1D) in Denmark, Iceland, Norway and Sweden, and uncovered predictors for increasing BMISDS. METHODS: Data registered in the Nordic national childhood diabetes databases during the period 2008-2012 on children below 15 years with T1D for more than 3 months were compiled, including information on gender, age, diabetes duration, hemoglobin A1c (HbA1c ), insulin dose, severe hypoglycemia (SH), treatment modality, height and weight. The Swedish reference chart for BMI was used for calculating BMISDS. RESULTS: Totally, 11 025 children (48% females) (30 994 registrations) were included. Medians by the last recorded examination were: age, 13.5 years; diabetes duration, 4.3 years; HbA1c , 7.9% (63 mmol/mol); insulin dose, 0.8 IU/kg/d and BMISDS, 0.70. Obesity rate was 18.5%. Adjusted mean BMISDS (BMISDS adj) was inversely related to HbA1c and directly to diabetes duration. Higher BMISDS adj was found in those with an insulin dose above 0.6 IU/kg/d, and in girls above 10 years. Pump users had higher BMISDS adj than pen users, and patients with registered SH had higher BMISDS adj than patients without SH (both P < .001). CONCLUSION:Obesity rate in children with T1D in the Nordic countries is high, however, with country differences. Low HbA1c , long diabetes duration, higher insulin dose, pump treatment and experiencing a SH predicted higher BMISDS. Diabetes caregivers should balance the risk of obesity and the benefit of a very low HbA1c.
Authors: Faisal S Malik; Katherine A Sauder; Scott Isom; Beth A Reboussin; Dana Dabelea; Jean M Lawrence; Alissa Roberts; Elizabeth J Mayer-Davis; Santica Marcovina; Lawrence Dolan; Daria Igudesman; Catherine Pihoker; Jean M Lawrence; Peggy Hung; Corinna Koebnick; Xia Li; Eva Lustigova; Kristi Reynolds; David J Pettitt; Elizabeth J Mayer-Davis; Amy Mottl; Joan Thomas; Malaka Jackson; Lisa Knight; Angela D Liese; Christine Turley; Deborah Bowlby; James Amrhein; Elaine Apperson; Bryce Nelson; Dana Dabelea; Anna Bellatorre; Tessa Crume; Richard F Hamman; Katherine A Sauder; Allison Shapiro; Lisa Testaverde; Georgeanna J Klingensmith; David Maahs; Marian J Rewers; Paul Wadwa; Stephen Daniels; Michael G Kahn; Greta Wilkening; Clifford A Bloch; Jeffrey Powell; Kathy Love-Osborne; Diana C Hu; Lawrence M Dolan; Amy S Shah; Debra A Standiford; Elaine M Urbina; Catherine Pihoker; Irl Hirsch; Grace Kim; Faisal A Malik; Lina Merjaneh; Alissa Roberts; Craig Taplin; Joyce Yi-Frazier; Natalie Beauregard; Cordelia Franklin; Carlo Gangan; Sue Kearns; Mary Klingsheim; Beth Loots; Michael Pascual; Carla Greenbaum; Giuseppina Imperatore; Sharon H Saydah; Barbara Linder; Santica M Marcovina; Alan Chait; Noemie Clouet-Foraison; Jessica Harting; Greg Strylewicz; Ralph D'Agostino; Elizabeth T Jensen; Lynne E Wagenknecht; Ronny A Bell; Ramon Casanova; Jasmin Divers; Maureen T Goldstein; Leora Henkin; Scott Isom; Kristin Lenoir; June Pierce; Beth Reboussin; Joseph Rigdon; Andrew Michael South; Jeanette Stafford; Cynthia Suerken; Brian Wells; Carrie Williams Journal: Diabetes Care Date: 2022-02-01 Impact factor: 19.112
Authors: Yun Jeong Lee; Young Ah Lee; Jae Hyun Kim; Hye Rim Chung; Min Jeong Gu; Ji Young Kim; Choong Ho Shin Journal: Ann Pediatr Endocrinol Metab Date: 2020-12-31