Certain kids with diabetes are most at risk for excess weight: study

Children and teens with type 1 diabetes are already at increased risk for becoming overweight or obese, but certain traits make the odds even higher, according to a new study.

Because obesity can compound some of the health problems that go along with diabetes, it’s important to help kids avoid weight gain, researchers say.

Elke Frohlich-Reiterer, of Medical University Graz in Austria, and her colleagues analyzed data collected from 250 diabetes centers in Germany and Austria; altogether, there were 12,774 participants in the study.

All the kids were under the age of 20 and had type 1 diabetes, which used to be known as juvenile diabetes because it typically appears during childhood.

In type 1 diabetes, the body’s immune system destroys the cells of the pancreas that normally produce the insulin necessary for processing sugars in food. The other variety - type 2 diabetes - occurs when the body doesn’t properly use insulin.

The children in the study were grouped by age: under five years, 5-10 years, 10-15 years and 15-20 years. They were also divided into categories based on how long they had had diabetes: less than two years, 2-5 years, 5-10 years and more than 10 years.

Certain kids with diabetes are most at risk for excess weight The researchers found that being female, a younger age when diabetes was first diagnosed and having diabetes for a longer time were all linked to a bigger jump in body mass index, a measure of weight relative to height and peer group.

Using short-acting insulin medicines was also linked to greater weight gain in girls, whereas using long-acting insulin was linked to more weight gain in boys.

Finally, girls who developed diabetes around the time they went through puberty - between the ages of 10 and 15 years old - were more likely to have gained excess weight.

“The increasing prevalence of overweight and obesity and associated risk factors among youth are major global health problems,” the authors write in the paper, which was published in the journal Archives of Disease in Childhood.

“As children and adolescents with type 1 diabetes are also at increased risk to develop overweight and obesity, weight gain is an important aspect in the care of children and adolescents with (the disease),” making it important to figure out which factors indicate a higher risk of this excess weight gain, they write.

The study reinforces what’s already known about young people with diabetes, who are at an increased risk of excess weight gain as they grow up, a researcher not involved in the study said.

But the new work also “provides additional insight into important factors for the development of obesity,” said Karen Peterson, a researcher in nutrition at the University of Michigan in Ann Arbor.

Weight gain among people with diabetes is especially detrimental because the risks of diabetes and obesity overlap and can be additive, she said.

“Higher weights can exacerbate the insulin resistance that comes with diabetes. And obesity has some of the same metabolic issues diabetes does, such as adding to risk factors (for heart disease),” Peterson told Reuters Health.

That’s why it’s particularly important for kids with diabetes to maintain healthy habits, keeping in mind that some weight gain during childhood and adolescence is normal and healthy.

Peterson recommends that parents track their child’s pattern of weight gain, but instead of focusing on weight, “emphasize an overall healthy diet that includes more fruits, veggies, and complex carbohydrates, and which is coupled with active play,” she said.

SOURCE: Archives of Disease in Childhood, online May 8, 2014


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


Objective Increased weight gain has been reported prior to disease onset (accelerator hypothesis) and as a side effect of intensified insulin therapy in type 1 diabetes (T1D). Paediatric studies are complicated by the age-dependency and gender-dependency of BMI, and also by a trend towards obesity in the general population. The aim of this study was to evaluate factors related to the increase in BMI during the course of diabetes in children and adolescents with T1D in a large multicentre survey.

Design Within the DPV database (Diabetespatienten Verlaufsdokumentation) a standardised, prospective, computer-based documentation programme, data of 53 108 patients with T1D, aged

<20 years, were recorded in 248 centres. 12 774 patients (53% male, mean age 13.4±3.9, mean diabetes duration 4.7±3.0 years and mean age at diabetes onset 8.7±4.0 years) were included in this analysis. Population-based German reference data were used to calculate BMI-SDS and define overweight and obesity.

Results 12.5% of T1D patients were overweight and 2.8% were obese. Multiple longitudinal regression analysis revealed that female gender, low BMI at diabetes onset, intensified insulin therapy and higher insulin dose, as well as pubertal diabetes onset, long diabetes duration and onset in earlier calendar years among girls, were related to higher BMI-SDS increase during the course of diabetes (p

<0.01; all).

Conclusions Intensified insulin regimen is associated with weight gain during T1D treatment, in addition to demographic variables. Optimisation of diabetes management, especially in females, might limit weight gain in order to reduce overweight and obesity together with comorbidities among paediatric T1D patients.

  Elke E Fröhlich-Reiterer,
  Joachim Rosenbauer,
  Susanne Bechtold-Dalla Pozza,
  Sabine E Hofer,
  Edith Schober,
  Reinhard W Holl,
  on behalf of the DPV-Wiss Study Group and the German BMBF Competence Networks Diabetes mellitus and Obesity

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