The metabolic consequences of overweight in a cohort of children with type 1 diabetes

Abstract Objective To estimate the prevalence of overweight and obesity among a cohort of children with type 1 diabetes mellitus (T1DM) and its metabolic consequences. Methods This was a cross-sectional study conducted in the Pediatric Diabetic Clinic at Shaare Zedek Medical Center and Clalit Health Care Services. Background information was taken from the patients’ files. Anthropometric measures, blood pressure, waist and hip circumference (WC and HC), hemoglobin A1c (HbA1c) and lipid profile were recorded. The prevalence of metabolic derangements was compared between normal and overweight children. Results The study included 96 patients with type 1 diabetes, mean age 14.1 ± 3.7 years, mean diabetes duration 3.9 ± 3 and mean HbA1c level 8.1 ± 1.4% (65 mmol/mol). Thirty-seven percent of the study population were overweight and of them 11.5% were obese. In the overweight group, the high-density lipoprotein (HDL) levels were significantly lower and systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were higher compared with normal weight participants. Multivariate analysis showed that BMI and age at study affected SBP and HDL levels, while age at study and HbA1c levels affected DBP. Female patients were significantly overweight compared to males and had higher low-density lipoprotein (LDL) and cholesterol levels. Waist-to-hip ratio, an indicator of central obesity, was abnormally high among overweight males and females. Conclusions In our cohort of children with type 1 diabetes, there were a significant number of overweight children, with a higher prevalence in females. Components of metabolic syndrome were more prevalent among overweight and obese diabetic individuals.

Download Full-text

Association between central non-dipping pattern and platelet morphology in adults with type 1 diabetes without cardiovascular disease: a cross-sectional study

Scientific Reports ◽

10.1038/s41598-021-94414-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Michal Kulecki ◽

Dariusz Naskret ◽

Mikolaj Kaminski ◽

Dominika Kasprzak ◽

Pawel Lachowski ◽

...

Keyword(s):

Blood Pressure ◽

Type 1 Diabetes ◽

Smoking Status ◽

Cross Sectional Study ◽

Cross Sectional ◽

Distribution Width ◽

Non Invasive ◽

Platelet Morphology ◽

Oscillometric Device

AbstractThe non-dipping pattern is nighttime systolic blood pressure (SBP) fall of less than 10%. Several studies showed that the non-dipping pattern, increased mean platelet volume (MPV), and platelet distribution width (PDW) are associated with elevated cardiovascular risk. Hypertensives with the non-dipping pattern have higher MPV than the dippers but this relationship was never investigated among people with type 1 diabetes mellitus (T1DM). This study aimed to investigate the association between the central dipping pattern and platelet morphology in T1DM subjects. We measured the central and brachial blood pressure with a validated non-invasive brachial oscillometric device—Arteriograph 24—during twenty-four-hour analysis in T1DM subjects without diagnosed hypertension. The group was divided based on the central dipping pattern for the dippers and the non-dippers. From a total of 62 subjects (32 males) aged 30.1 (25.7–37) years with T1DM duration 15.0 (9.0–20) years, 36 were non-dippers. The non-dipper group had significantly higher MPV (MPV (10.8 [10.3–11.5] vs 10.4 [10.0–10.7] fl; p = 0.041) and PDW (13.2 [11.7–14.9] vs 12.3 [11.7–12.8] fl; p = 0.029) than dipper group. Multivariable logistic regression revealed that MPV (OR 3.74; 95% CI 1.48–9.45; p = 0.005) and PDW (OR 1.91; 95% CI 1.22–3.00; p = 0.005) were positively associated with central non-dipping pattern adjusting for age, sex, smoking status, daily insulin intake, and height. MPV and PDW are positively associated with the central non-dipping pattern among people with T1DM.

Download Full-text

Accessibility and Openness to Diabetes Management Support via Mobile Phones: A Survey of People with Type 1 Diabetes Using Advanced Diabetes Technologies (Preprint)

10.2196/preprints.36140 ◽

2022 ◽

Author(s):

Yu Kuei Lin ◽

Caroline Richardson ◽

Iulia Dobrin ◽

Rodica Pop-Busui ◽

Gretchen Piatt ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetes Management ◽

Interactive Voice Response ◽

Medical Center ◽

Academic Medical Center ◽

Text Messages ◽

Management Support ◽

Cross Sectional Survey ◽

Cross Sectional

BACKGROUND Little is known about the feasibility of mobile health (mHealth) support among people with type 1 diabetes (T1D) using advanced diabetes technologies including continuous glucose monitors (CGMs) and hybrid closed-loop insulin pumps (HCLs). OBJECTIVE To evaluate patient access and openness to receiving mHealth diabetes support in people with T1D using CGMs/HCLs. METHODS We conducted a cross-sectional survey among T1D patients using CGMs or HCLs managed in an academic medical center. Participants reported information regarding their mobile device usage, cellular call/text message/internet connectivity, and openness to various channels of mHealth communication (smartphone applications or “apps”, text messages, and interactive voice response calls or IVR calls). Participants’ demographic characteristics and CGM data were collected from medical records. Analyses focused on differences in openness to mHealth and mHealth communication channels across groups defined by demographic variables and measures of glycemic control. RESULTS Among all participants (n=310; 64% female; mean age: 45 (SD:16)), 98% reported active cellphone use, and 80% were receptive to receiving mHealth support to improve glucose control. Among participants receptive to mHealth support, 98% were willing to share CGM glucose data for mHealth diabetes self-care assistance. Most (71%) were open to receiving messages via apps, 56% were open to text messages, and 12% were open to IVR calls. Older participants were more likely to prefer text messages (P=0.009) and IVR (P=0.03) than younger participants. CONCLUSIONS Most people with T1D who use advanced diabetes technologies have access to cell phones and are receptive to receiving mHealth support to improve diabetes control. CLINICALTRIAL Not applicable

Download Full-text

Depression in type 1 diabetes was associated with high levels of circulating galectin-3

Endocrine Connections ◽

10.1530/ec-18-0108 ◽

2018 ◽

Vol 7 (6) ◽

pp. 819-828 ◽

Cited By ~ 11

Author(s):

Eva Olga Melin ◽

Jonatan Dereke ◽

Maria Thunander ◽

Magnus Hillman

Keyword(s):

Blood Pressure ◽

Type 1 Diabetes ◽

Depression Scale ◽

Cardiovascular Complications ◽

Lipid Lowering ◽

Cross Sectional ◽

Diabetes Registry ◽

Increased Risk ◽

Galectin 3

Objective Neuroinflammatory responses are implicated in depression. The aim was to explore whether depression in patients with type 1 diabetes (T1D) was associated with high circulating galectin-3, controlling for metabolic variables, s-creatinine, life style factors, medication and cardiovascular complications. Design Cross-sectional. Methods Participants were T1D patients (n = 283, 56% men, age 18–59 years, diabetes duration ≥1 year). Depression was assessed by Hospital Anxiety and Depression Scale-depression subscale. Blood samples, anthropometrics and blood pressure were collected, and supplemented with data from medical records and the Swedish National Diabetes Registry. Galectin-3 ≥2.562 µg/l, corresponding to the 85th percentile, was defined as high galectin-3. Results Median (quartile1, quartile3) galectin-3 (µg/l) was 1.3 (0.8, 2.9) for the 30 depressed patients, and 0.9 (0.5, 1.6) for the 253 non-depressed, P = 0.009. Depression was associated with high galectin-3 in all the 283 patients (adjusted odds ratio (AOR) 3.5), in the 161 men (AOR 3.4), and in the 122 women (AOR 3.9). HbA1c, s-lipids, s-creatinine, blood pressure, obesity, smoking, physical inactivity, cardiovascular complications and drugs (antihypertensive, lipid lowering, oral antidiabetic drugs and antidepressants) were not associated with high galectin-3. Conclusions This is the first study to show an association between depression and galectin-3. Depression was the only explored parameter associated with high circulating galectin-3 levels in 283 T1D patients. High galectin-3 levels might contribute to the increased risk for Alzheimer’s disease, cardiovascular and all-cause mortality observed in persons with depression. Potentially, in the future, treatment targeting galactin-3 might improve the prognosis for patients with high galectin-3 levels.

Download Full-text

The Association between Treatment Modality, Lipid Profile, Metabolic Control in Children with Type 1 Diabetes and Celiac Disease—Data from the International Sweet Registry

Nutrients ◽

10.3390/nu13124473 ◽

2021 ◽

Vol 13 (12) ◽

pp. 4473

Author(s):

Monica Marino ◽

Alexander J. Eckert ◽

Shoshana Tell ◽

Nevena Krnic ◽

Grazyna Deja ◽

...

Keyword(s):

Type 1 Diabetes ◽

Celiac Disease ◽

Lipid Profile ◽

Metabolic Control ◽

Treatment Modality ◽

Cross Sectional Study ◽

Overweight And Obesity ◽

Diabetes Duration ◽

Cross Sectional

Background and Aims: A higher frequency of dyslipidemia is reported in children with type 1 diabetes (T1D) and celiac disease (CD). Recently, continuous subcutaneous insulin infusion (CSII) has been associated with better lipid profiles in patients with T1D. The aim of this study was to investigate the association between treatment modality and lipid profile, metabolic control, and body mass index (BMI)-SDS in children with both T1D and CD. Methods: Cross-sectional study in children registered in the international SWEET database in November 2020. Inclusion criteria were children (2–18 years) with T1D and CD with available data on treatment modality (CSII and injections therapy, IT), triglyceride, total cholesterol, HDL, LDL, dyslipidemia, HbA1c, and BMI-SDS. Overweight/obesity was defined as > +1 BMI-SDS for age. Data were analyzed by linear and logistical regression models with adjustment for age, gender, and diabetes duration. Results: In total 1009 children with T1D and CD (female 54%, CSII 54%, age 13.9 years ±3.6, diabetes duration 7.2 years ±4.1, HbA1c 7.9% ±1.4) were included. Significant differences between children treated with CSII vs. IT were respectively found; HDL 60.0 mg/dL vs. 57.8 mg/dL, LDL 89.4 mg/dL vs. 94.2 mg/dL, HbA1c 7.7 vs. 8.1%, BMI-SDS 0.4 vs. 0.6, overweight and obesity 17% vs. 26% (all p < 0.05). Conclusions: CSII is associated with higher HDL and lower LDL, HbA1c, BMI-SDS, and percentage of overweight and obesity compared with IT in this study. Further prospective studies are required to determine whether CSII improves lipid profile, metabolic control and normalize body weight in children with both T1D and CD.

Download Full-text

Evaluation of lipid profile among children and adolescents with type 1 diabetes mellitus in Bangladesh

Mediscope ◽

10.3329/mediscope.v5i1.36721 ◽

2018 ◽

Vol 5 (1) ◽

pp. 15-21

Author(s):

M Parveen ◽

MA Muttalib ◽

ST Huq ◽

N Nazneen ◽

MA Kabir ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Children And Adolescents ◽

Density Lipoprotein ◽

Lipoprotein Cholesterol ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Detailed Medical History

The study, a cross-sectional survey, was carried out at the Department of Biochemistry in Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) General Hospital from July 2015 to June 2016. A total of 576 clinically diagnosed children and adolescents with type 1 diabetes mellitus (T1DM) aged 10-18 years attending in ‘Changing Diabetes in Children’ clinic, BIRDEM-2, Dhaka were selected according to appropriate inclusion and exclusion criteria. The study subjects underwent detailed medical history and examination. Fasting blood samples were drawn from the participants for biochemical assays such as fasting blood sugar (FBS), glycated haemoglobin (HbA1c), total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides. Anthropometric data and blood pressures both systolic and diastolic were measured. Student unpaired t-test and Chi-square test were used to determine the association between different groups. Out of 576 T1DM patients, 45.0% (259) were male and 55.0% (317) were female. Of the 576 T1DM patients, 35.1% were without dyslipidemia (DLP) and 64.9% were with DLP. Study revealed that the patients with DLP were more likely to have higher values of HbA1c (10.1±2.2% vs 9.4±1.9%, p < 0.001) and FBS (13.0±4.4 mmol/L vs 10.2±2.9 mmol/L, p < 0.001). A substantial proportion of children and adolescents with T1DM had DLP. We found an association between poor glycemic control and abnormal lipid profiles in those patients. Mediscope Vol. 5, No. 1: Jan 2018, Page 15-21

Download Full-text

Melatonin and cryptochrome 2 in metabolic syndrome patients with or without diabetes: a cross-sectional study

Hormone Molecular Biology and Clinical Investigation ◽

10.1515/hmbci-2018-0016 ◽

2018 ◽

Vol 35 (2) ◽

Cited By ~ 3

Author(s):

Ibrahim Abdul Kareem Al-Sarraf ◽

Violet Kasabri ◽

Amal Akour ◽

Randa Naffa

Keyword(s):

Blood Pressure ◽

Metabolic Syndrome ◽

Density Lipoprotein ◽

Cross Sectional Study ◽

Overweight And Obesity ◽

P Value ◽

Metabolic Risk ◽

Sectional Study ◽

Cross Sectional ◽

Cryptochrome 2

Abstract Background Metabolic syndrome (MetS) is a cluster of metabolic risk factors which increases the chances for future cardiovascular diseases, as well as diabetes. The underlying causes of MetS include overweight and obesity, physical inactivity and genetic factors. Our intension here was to focus in this study on the importance of the chronobiology, represented by melatonin (MT) and cryptochrome 2 (CRY2), in developing MetS and type 2 diabetes mellitus (T2DM). Thus, we aimed to compare MT and CRY2 plasma levels and correlate both biomarkers with adiposity, atherogenicity and hematological indices in MetS and T2DM cohorts. Methods In a cross-sectional study, 28 normoglycemic lean subjects (controls), 29 normoglycemic MetS subjects and 30 MetS (pre-diabetic/diabetic) were recruited. Results MT (pg/mL) was elevated significantly in MetS arm p-value < 0.05, whereas CRY2 levels (ng/mL) were markedly higher in both MetS groups (non-diabetic and pre-diabetic/diabetic) (all with p-value < 0.001). A reciprocal MT-CRY2 relationship was observed in the MetS (non-diabetic) group (p-value = 0.003). Of note in the total study population, both MT and CRY2 proportionally correlated with each of the following: atherogenicity index of plasma (AIP), waist circumference (WC) and systolic blood pressure (SBP) (all with p-value < 0.05) for MT and CRY2, respectively). Whereas MT correlated inversely with high-density lipoprotein-cholesterol (HDL-C) (p-value < 0.05). Additionally, CRY2 correlated directly with each of the following: diastolic blood pressure (DBP), total cholesterol (TC), low-density lipoprotein (LDL-C), hip circumference (HC), body adiposity index (BAI), weight-to-height (WHtR) ratio, mean platelet volume (MPV) and platelet/lymphocyte ratio (PLR) (p-value < 0.05). Conclusion These findings substantiate that both metabolic risk biomarkers can be prognostic tools and pharmacotherapeutic targets to slowdown the accelerated nature of T2DM.

Download Full-text

Shoulder Adhesive Capsulitis in Type 1 Diabetes Mellitus: A Cross-Sectional Study on 943 Cases in Sardinian People

Joints ◽

10.1055/s-0037-1605555 ◽

2017 ◽

Vol 05 (03) ◽

pp. 143-146 ◽

Cited By ~ 1

Author(s):

Carlo Doria ◽

Giulia Mosele ◽

Francesca Badessi ◽

Leonardo Puddu ◽

Gianfilippo Caggiari

Keyword(s):

Diabetes Mellitus ◽

Blood Pressure ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Adhesive Capsulitis ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Significant Difference

Purpose To evaluate the prevalence of adhesive capsulitis (AC) of the shoulder in patients with type 1 diabetes mellitus (T1DM) in Sardinia. Methods In this cross-sectional study, we evaluated 943 patients with T1DM attending the division of Endocrinology and Metabolism at the University Hospital in Sassari, Italy. The criteria for diagnosing AC were: pain for at least 1 month, inability to lie on the affected shoulder, and restricted active and passive shoulder joint movements in at least three planes. Age, gender, duration of DM, blood pressure, and presence of neuropathy and retinopathy were noted. Metabolic control of DM was evaluated with glycosylated hemoglobin A1c (GHbA1c) blood concentrations. Results AC was diagnosed in 331 patients (prevalence: 35.1%). Age, duration of DM, high blood pressure levels, and the presence of neuropathy and retinopathy were significantly associated with AC. No significant association was observed between gender and AC. There was no significant difference in mean levels of GHbA1c in T1DM patients with or without AC. Conclusion This study shows that AC of the shoulder is a common disorder in patients with T1DM in Sardinia. It is significantly associated with age, duration of DM, and related complications. Level of Evidence Level IV, observational cross-sectional study.

Download Full-text

Elevated blood pressure and its relationship with bodyweight and anthropometric measurements among 8–11-year-old Indonesian school children

Journal of Public Health Research ◽

10.4081/jphr.2020.1723 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Nawanto Agung Prastowo ◽

Ignatio Rika Haryono

Keyword(s):

Blood Pressure ◽

School Children ◽

Pearson Correlation ◽

Cross Sectional Study ◽

Overweight And Obesity ◽

Elevated Blood Pressure ◽

Elevated Blood ◽

Chi Square ◽

Anthropometric Measures ◽

Cross Sectional

Objective: Increased prevalence of elevated blood pressure in children and adolescents was associated with increased body weight and measures. Also, prevalence of elevated blood pressure varies between countries. This study is to investigate the prevalence of elevated blood pressure in Indonesian children and its relationship with bodyweight and anthropometric measures.Methods: This cross-sectional study involved 1010 elementary students aged 8–12 years (479 girls, 531 boys). The anthropometric measures and blood pressure were assessed. Elevated blood pressure (EBP) was determined if at the 90th percentile or above for gender, age, and height. Independent t-test, Chi-square, Pearson correlation, and multivariate logistic regression were applied. Significance was determined at p<0.05.Results: Overall prevalence of EBP was 28.8% (35.9% in girls, 22.4% in boys). BMI, waist circumference (WC), waist to height ratio (WHtR), and abdominal skinfold had significant correlation with EBP. Elevated BP was higher in overweight and obesity than in normoweight (60.5% vs 39.5%, p=0.00). In girls, the OR of EBP for overweight and obesity were 2.33 (95% CI 1.40 - 3.87, p=0.03) and 3.44 (95% CI 1.98 - 5.99, p=0.00) whereas in boys were 4.26 (95% CI 2.20 - 8.28, p=0.00) and 8.82 (95% CI 5.10 - 15.38, p=0.00).Conclusions: Prevalence of EBP in Indonesian school children aged 8-11 years was higher and more prevalent in overweight/obesity and in girls. Anthropometric measures were correlated with EBP.

Download Full-text

Determinants of Cardiovascular Risk in 7000 Youth With Type 1 Diabetes in the Australasian Diabetes Data Network

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa727 ◽

2020 ◽

Vol 106 (1) ◽

pp. 133-142

Author(s):

Jenny J Couper ◽

Timothy W Jones ◽

Melissa Chee ◽

Helen L Barrett ◽

Philip Bergman ◽

...

Keyword(s):

Blood Pressure ◽

Type 1 Diabetes ◽

Cardiovascular Risk ◽

Ldl Cholesterol ◽

Density Lipoprotein ◽

Hdl Cholesterol ◽

Urinary Albumin ◽

Indigenous Youth ◽

Z Scores

Abstract Context Cardiovascular disease occurs prematurely in type 1 diabetes. The additional risk of overweight is not well characterized. Objective The primary aim was to measure the impact of body mass index (BMI) in youth with type 1 diabetes on cardiovascular risk factors. The secondary aim was to identify other determinants of cardiovascular risk. Design Observational longitudinal study of 7061 youth with type 1 diabetes followed for median 7.3 (interquartile range [IQR] 4-11) years over 41 (IQR 29-56) visits until March 2019. Setting 15 tertiary care diabetes centers in the Australasian Diabetes Data Network. Participants were aged 2 to 25 years at baseline, with at least 2 measurements of BMI and blood pressure. Main Outcome Measure Standardized systolic and diastolic blood pressure scores and non–high-density lipoprotein (HDL) cholesterol were co-primary outcomes. Urinary albumin/creatinine ratio was the secondary outcome. Results BMI z-score related independently to standardized blood pressure z- scores and non-HDL cholesterol. An increase in 1 BMI z-score related to an average increase in systolic/diastolic blood pressure of 3.8/1.4 mmHg and an increase in non-HDL cholesterol (coefficient + 0.16 mmol/L, 95% confidence interval [CI], 0.13-0.18; P < 0.001) and in low-density lipoprotein (LDL) cholesterol. Females had higher blood pressure z-scores, higher non-HDL and LDL cholesterol, and higher urinary albumin/creatinine than males. Indigenous youth had markedly higher urinary albumin/creatinine (coefficient + 2.15 mg/mmol, 95% CI, 1.27-3.03; P < 0.001) and higher non-HDL cholesterol than non-Indigenous youth. Continuous subcutaneous insulin infusion was associated independently with lower non-HDL cholesterol and lower urinary albumin/creatinine. Conclusions BMI had a modest independent effect on cardiovascular risk. Females and Indigenous Australians in particular had a more adverse risk profile.

Download Full-text

T1DMicro: A Clinical Risk Calculator for Type 1 Diabetes Related Microvascular Complications

10.1101/2021.09.01.21262996 ◽

2021 ◽

Author(s):

Paul Minh Huy Tran ◽

Eileen Kim ◽

Lynn Kim Hoang Tran ◽

bin Satter Khaled ◽

Wenbo Zhi ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Type 1 Diabetes ◽

Systolic Blood Pressure ◽

Microvascular Complications ◽

Cross Sectional ◽

Average Systolic Blood Pressure ◽

Clinical Risk ◽

C Statistic

AbstractDevelopment of complications in type-1 diabetes patients can be reduced by modifying risk factors. We used a cross-sectional cohort of 1646 patients diagnosed with type 1 diabetes (T1D) to develop a clinical risk score for diabetic peripheral neuropathy (DPN), autonomic neuropathy (AN), retinopathy (DR), and nephropathy (DN). Of these patients, 199 (12.1%) had DPN, 63 (3.8%) had AN, 244 (14.9%) had DR, and 88 (5.4%) had DN. We selected five variables to include in each of the four microvascular complications risk models: age, age of T1D diagnosis, duration of T1D, and average systolic blood pressure and HbA1C over the last three clinic visits. These variables were selected for their strong evidence of association with diabetic complications in the literature and because they are modifiable risk factors. We found the optimism-corrected R2 and Harrell’s C statistic were 0.39 and 0.87 for DPN, 0.24 and 0.86 for AN, 0.49 and 0.91 for DR, and 0.22 and 0.83 for DN respectively.This tool (https://ptran25.shinyapps.io/Diabetic_Peripheral_Neuropathy_Risk) was built to help inform patients of their current risk of microvascular complications and to motivate patients to control their HbA1c and systolic blood pressure in order to reduce their risk of these complications.

Download Full-text