Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter June 23, 2021

Evaluation of children with type 1 diabetes mellitus in terms of overweight/obesity in tertiary care hospital

  • Eda Celebi Bitkin EMAIL logo , Cengiz Kara , Gülay Can Yılmaz , Jamala Mammadova and Hasan Murat Aydın

Abstract

Objectives

Obesity is a growing problem in type 1 diabetes mellitus (T1DM) today. The aim of our study is to determine the frequency of overweight/obesity at the time of diagnosis and during follow-up in children with T1DM as well as review the conditions that may accompany.

Methods

A total of 315 patients with T1DM were retrospectively analyzed. The patients were divided into two groups as normal weight and overweight/obese. The two groups were compared in terms of age at diagnosis, birth weight, anthropometric measurements, insulin dose used and blood pressure measurements, and insulin, c-peptide, hemoglobin A1c, triglyceride, and high-density lipoprotein levels at the time of diagnosis and follow-up.

Results

The height, weight and body mass index standard deviation (BMI SD) scores, and c-peptide levels at the time of diagnosis of the overweight/obese group were higher than those with normal weight (p<0.001 and p = 0.008, respectively). The frequency of dyslipidemia and hypertension was higher in the overweight/obese group than in the normal weight group [18.2 vs. 5% (p = 0.015) and 10 vs. 1.5% (p = 0.003), respectively].

Conclusions

In our study, the fact that the overweight/obese group had higher BMI and c-peptide and lower HDL values at the time of diagnosis can be evaluated as indicators that insulin resistance syndrome can accompany T1DM from the beginning (double diabetes). When determining the treatment and follow-up strategies of patients with T1DM, considering the risk of obesity and taking the necessary precautions is very important in terms of morbidity.


Corresponding author: Eda Celebi Bitkin, MD, Department of Pediatrics, Van Yüzüncü Yıl University, Faculty of Medicine, Division of Pediatric Endocrinology, Van, Turkey, Phone: +90 530 7642406, Fax:+90 432 4865413, E-mail:

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Our study was approved by the local ethics committee of our hospital with decision number 2018/393.

References

1. Dabelea, D, Mayer-Davis, EJ, Saydah, S, Imperatore, G, Linder, B, Divers, J, et al.. SEARCH for Diabetes in Youth Study. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. J Am Med Assoc 2014;311:1778–86. https://doi.org/10.1001/jama.2014.3201.Search in Google Scholar

2. NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 2017;390(10113):2627–2642.10.1016/S0140-6736(17)32129-3Search in Google Scholar

3. NCD Risk Factor Collaboration (NCD-RisC). Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet 2016;387:1377–96. https://doi.org/10.1016/S0140-6736(16)30054-X.Search in Google Scholar

4. The GBD 2015. Obesity Collaborators Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017; 377:13–27.10.1056/NEJMoa1614362Search in Google Scholar PubMed PubMed Central

5. Kahn, SE, Hull, RL, Utzschneider, KM. Mechanisms linking obesity to insulin resistance and type 2 diabetes. Nature 2006;444:840–6. https://doi.org/10.1038/nature05482.Search in Google Scholar PubMed

6. Szadkowska, A, Madej, A, Ziolkowska, K, Szymanska, M, Jeziorny, K, Mianowska, B, et al.. Gender and age-dependent effect of type 1 diabetes on obesity and altered body composition in young adults. Ann Agric Environ Med 2015;22:124–8. https://doi.org/10.5604/12321966.1141381.Search in Google Scholar PubMed

7. Corbin, KD, Driscoll, KA, Pratley, RE, Smith, SR, Maahs, DM, Mayer-Davis, EJ. Advancing Care for type 1 diabetes and obesity network (ACT1ON). Obesity in type 1 diabetes: pathophysiology, clinical impact, and mechanisms. Endocr Rev 2018;39:629–63. https://doi.org/10.1210/er.2017-00191.Search in Google Scholar PubMed

8. Conway, B, Miller, RG, Costacou, T, Fried, L, Kelsey, S, Evans, RW, et al.. Temporal patterns in overweight and obesity in type 1 diabetes. Diabet Med 2010;27:398–404. https://doi.org/10.1111/j.1464-5491.2010.02956.x.Search in Google Scholar PubMed PubMed Central

9. Heptulla, RA, Stewart, A, Enocksson, S, Rife, F, Ma, TY, Sherwin, RS, et al.. In situ evidence that peripheral insulin resistance in adolescents with poorly controlled type 1 diabetes is associated with impaired suppression of lipolysis: a microdialysis study. Pediatr Res 2003;53:830–5. https://doi.org/10.1203/01.pdr.0000059552.08913.b7.Search in Google Scholar

10. Perseghin, G, Lattuada, G, Danna, M, Sereni, LP, Maffi, P, De Cobelli, F, et al.. Insulin resistance, intramyocellular lipid content and plasma adiponectin in patients with type 1 diabetes. Am J Physiol Endocrinol Metab 2003;285:1174–81. https://doi.org/10.1152/ajpendo.00279.2003.Search in Google Scholar PubMed

11. Paul, F, David, F, Peter, W, Georg, H, Anton, L, Michael, K, et al.. Overweight and obesity in type 1 diabetes equal those of the general population. Wien Klin Wochenschr 2019;131:55–60. https://doi.org/10.1007/s00508-019-01558-z.Search in Google Scholar

12. Demir, K, Konakçı, E, Özkaya, G, Kasap Demir, B, Özen, S, Aydın, M, et al.. New features for child metrics: further growth references and blood pressure calculations. J Clin Res Pediatr Endocrinol 2020;12:125–9. https://doi.org/10.4274/jcrpe.galenos.2019.2019.0127.Search in Google Scholar

13. Tümer, N, Yalçinkaya, F, Ince, E, Ekim, M, Köse, K, Cakar, N, et al.. Blood pressure nomograms for children and adolescents in Turkey. Pediatr Nephrol 1999;13:438–43. https://doi.org/10.1007/s004670050636.Search in Google Scholar

14. Yayıcı Köken, O, Kara, C, Can Yılmaz, G, Murat Aydın, H. Prevalence of obesity and metabolic syndrome in children with type 1 diabetes: a comparative assessment based on criteria established by the international diabetes federation, world health organisation and national cholesterol education program. J Clin Res Pediatr Endocrinol 2020;12:55–62.10.4274/jcrpe.galenos.2019.2019.0048Search in Google Scholar

15. Zimmet, P, Alberti, G, Kaufman, F, Tajima, N, Silink, M, Arslanian, S, et al.. International diabetes federation task force on epidemiology and prevention of diabetes. The metabolic syndrome in children and adolescents. Lancet 2007;369:2059–61. https://doi.org/10.1016/s0140-6736(07)60958-1.Search in Google Scholar

16. Bereket, A. Current status of childhood obesity and its associated morbidities in Turkey. J Clin Res Pediatr Endocrinol 2012;4:1–7. https://doi.org/10.4274/jcrpe.506.Search in Google Scholar PubMed PubMed Central

17. Çelmeli, G, Çürek, Y, Arslan Gülten, Z, Yardımsever, M, Koyun, M, Akçurin, S, et al.. Remarkable increase in the prevalence of overweight and obesity among school age children in antalya, Turkey, between 2003 and 2015. J Clin Res Pediatr Endocrinol 2019;11:76–81. https://doi.org/10.4274/jcrpe.galenos.2018.2018.0108.Search in Google Scholar PubMed PubMed Central

18. Kaya, M, Sayan, A, Birinci, M, Yildiz, M, Türkmen, K. The obesity prevalence among students between the ages of 5 and 19 in Kütahya. Turk J Med Sci 2014;44:10–15. https://doi.org/10.3906/sag-1301-71.Search in Google Scholar PubMed

19. Krochik, AG, Botto, M, Bravo, M, Hepner, M, Frontroth, JP, Miranda, M, et al.. Association between insulin resistance and risk of complications in children and adolescents with type 1 diabetes. Diabetes Metab Syndr 2015;9:14–18. https://doi.org/10.1016/j.dsx.2014.09.013.Search in Google Scholar PubMed

20. Pinhas-Hamiel, O, Levek-Motola, N, Kaidar, K, Boyko, V, Tisch, E, Mazor-Aronovitch, K, et al.. Prevalence of overweight, obesity and metabolic syndrome components in children, adolescents and young adults with type 1 diabetes mellitus. Diabetes Metab Res Rev 2015;31:76–84. https://doi.org/10.1002/dmrr.2565.Search in Google Scholar PubMed

21. Sandhu, N, Witmans, MB, Lemay, JF, Crawford, S, Jadavji, N, Pacaud, D. Prevalence of overweight And obesity in children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2008;21:631–40. https://doi.org/10.1515/jpem.2008.21.7.631.Search in Google Scholar

22. Ferreira-Hermosillo, A, Ramírez-Rentería, C, Mendoza-Zubieta, V, Molina-Ayala, MA. Utility of the waist-to-height ratio, waist circumference and body mass index in the screening of metabolic syndrome in adult patients with type 1 diabetes mellitus. Diabetol Metab Syndr 2014;6:32. https://doi.org/10.1186/1758-5996-6-32.Search in Google Scholar

23. Castro-Correia, C, Santos-Silva, R, Pinheiro, M, Costa, C, Fontoura, M. Metabolic risk factors in adolescent girls with type 1 diabetes. J Pediatr Endocrinol Metab 2018;31:631–5. https://doi.org/10.1515/jpem-2018-0053.Search in Google Scholar

24. Fröhlich-Reiterer, EE, Rosenbauer, J, Pozza, SBD, Hofer, SE, Schober, E, Holl, RW. Predictors of increasing BMI during the course of diabetes in children and adolescents with type 1 diabetes: data from the German/Austrian DPV multicentre survey. Arch Dis Child 2014;99:738–43. https://doi.org/10.1136/archdischild-2013-304237.Search in Google Scholar

25. Ludvigsson, J, Samuelsson, U. Continuous insulin infusion (CSII) or modern type of multiple daily injections (MDI) in diabetic children and adolescents a critical review on a controversial issue. Pediatr Endocrinol Rev 2007;5:666–78.Search in Google Scholar

26. Russell-Jones, D, Khan, R. Insulin-associated weight gain in diabetes—causes, effects and coping strategies. Diabetes Obes Metab 2007;9:799–812. https://doi.org/10.1111/j.1463-1326.2006.00686.x.Search in Google Scholar

27. DCCT Research Group. Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Am J Cardiol 1995;75:894–903. https://doi.org/10.1016/s0002-9149(99)80683-3.Search in Google Scholar

28. Ahmed, ML, Ong, KKL, Watts, AP, Morrell, DJ, Preece, MA, Dunger, DB. Elevated leptin levels are associated with excess gains in fat mass in girls, but not boys, with type 1 diabetes: longitudinal study during adolescence. J Clin Endocrinol Metab 2001;86:1188–93. https://doi.org/10.1210/jcem.86.3.7320.Search in Google Scholar PubMed

29. Steigleder-Schweiger, C, Rami-Merhar, B, Waldhör, T, Elke, FR, Ines, S, Maria, F, et al.. Prevalence of cardiovascular risk factors in children and adolescents with type 1 diabetes in Austria. Eur J Pediatr 2012;171:1193–202. https://doi.org/10.1007/s00431-012-1704-x.Search in Google Scholar PubMed

30. Flechtner-Mors, M, Schwab, KO, Fröhlich-Reiterer, EE, Kapellen, TM, Meissner, T, Rosenbauer, J, et al.. Holl overweight and obesity based on four reference systems in 18,382 paediatric patients with type 1 diabetes from Germany and Austria. J Diabetes Res 2015;2015:370753. https://doi.org/10.1155/2015/370753.Search in Google Scholar PubMed PubMed Central

31. Blüher, S, Molz, E, Wiegand, S, Otto, KP, Sergeyev, E, Tuschy, S, et al.. Body mass index, waist circumference, and waist-to-height ratio as predictors of cardiometabolic risk in childhood obesity depending on pubertal development. J Clin Endocrinol Metab 2013;98:3384–93. https://doi.org/10.1210/jc.2013-1389.Search in Google Scholar PubMed

32. Flechtner-Mors, M, Thamm, M, Wiegand, S, Reinehr, T, Schwab, KO, Kiess, W, et al.. Comorbidities related to BMI category in children and adolescents: German/Austrian/Swiss obesity register APV compared to the German KiGGS study. Horm Res Paediatr 2012;77:19–26. https://doi.org/10.1159/000334147.Search in Google Scholar

33. Schwab, KO, Doerfer, J, Marg, W, Schober, E, Holl, RW. Characterization of 33 488 children and adolescents with type 1 diabetes based on the gender-specific increase of cardiovascular risk factors. Pediatr Diabetes 2010;11:357–63. https://doi.org/10.1111/j.1399-5448.2010.00665.x.Search in Google Scholar

34. Gerstl, E-M, Rabl, W, Rosenbauer, J, Gröbe, H, Hofer, SE, Krause, U, et al.. Metabolic control as reflected by HbA1c in children, adolescents and young adults with type-1 diabetes mellitus: combined longitudinal analysis including 27,035 patients from 207 centers in Germany and Austria during the last decade. Eur J Pediatr 2008;167:447–53. https://doi.org/10.1007/s00431-007-0586-9.Search in Google Scholar

35. Frohlich-Reiterer, EE. Predictors of increasing BMI during the course of diabetes in children and adolescents with type 1 diabetes: data from the German/Austrian DPV multicentre survey. Arch Dis Child 2014;99:738–43. https://doi.org/10.1136/archdischild-2013-304237.Search in Google Scholar

36. Castro-Correia, C, Santos-Silva, R, Pinheiro, M, Costa, C, Fontoura, M. Metabolic risk factors in adolescent girls with type 1 diabetes. J Pediatr Endocrinol Metab 2018;27. 31:631–5. https://doi.org/10.1515/jpem-2018-0053.Search in Google Scholar

37. Giuffrida, FM, Bulcao, C, Cobas, RA, Negrato, CA, Gomes, MB, Dib, SA. Double-diabetes in a real-world sample of 2711 individuals: associated with insulin treatment or part of the heterogeneity of type 1 diabetes? Diabetol Metab Syndr 2016;8:28. https://doi.org/10.1186/s13098-016-0143-7.Search in Google Scholar

38. Bush, MA. Intensive diabetes therapy and body weight: focus on insulin detemir. Endocrinol Metab Clin N Am 2007;36:33–44. https://doi.org/10.1016/s0889-8529(07)80006-5.Search in Google Scholar

39. Timar, R, Timar, B, Degeratu, D, Serafinceanu, C, Oancea, C. Metabolic syndrome, adiponectin and proinflammatory status in patients with type 1 diabetes mellitus. J Int Med Res 2014;42:1131–8. https://doi.org/10.1177/0300060514541829.Search in Google Scholar PubMed

40. Esposito, K, Nappo, F, Marfella, R, Giugliano, G, Giugliano, F, Ciotola, M, et al.. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation 2002;106:2067–72. https://doi.org/10.1161/01.cir.0000034509.14906.ae.Search in Google Scholar PubMed

41. Lakka, TA, Lakka, HM, Rankinen, T, Leon, AS, Rao, DC, Skinner, JS, et al.. Effect of exercise training on plasma levels of C-reactive protein in healthy adults: the HERITAGE Family Study. Eur Heart J 2005;26:2018–25. https://doi.org/10.1093/eurheartj/ehi394.Search in Google Scholar PubMed

42. Colberg, SR, Laan, R, Dassau, E, Kerr, D. Physical activity and type 1 diabetes: time for a rewire? J Diabetes Sci Technol 2015;9:609–18. https://doi.org/10.1177/1932296814566231.Search in Google Scholar PubMed PubMed Central

Received: 2021-04-12
Accepted: 2021-05-10
Published Online: 2021-06-23
Published in Print: 2021-08-26

© 2021 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 4.6.2024 from https://www.degruyter.com/document/doi/10.1515/jpem-2021-0268/html
Scroll to top button