Young children, adolescent girls and women with type 1 diabetes are more overweight and obese than reference populations, and this is associated with increased cardiovascular risk factors

Abstract

Aim Overweight and obesity are frequently reported in young persons with type 1 diabetes, however its relative magnitude in comparison to the general population is not well understood. This study compared the prevalence of overweight and obesity in young persons with type 1 diabetes to a reference population and explored possible associated factors, including gender, age, HbA1c, insulin regimen, age at diagnosis, diabetes duration, socio‐economic status and cardiovascular disease risk factors. Methods A cross‐sectional review was undertaken of data collected from youth (3–17 years) in 2016 and young adults (18–30 years) in 2015 with a diagnosis of type 1 diabetes for > 3 months attending diabetes centres in Newcastle, Australia. Rates of overweight and obesity were compared with matched population survey results. Results Data from 308 youth and 283 young adults were included. In girls, significantly higher prevalence of overweight and obesity were seen in the 5–8 (43% vs. 18%), 13–16 (41% vs. 27%), 18–24 (46% vs. 34%) and 25–30 (60% vs. 43%) years age groups; whereas in boys increased prevalence was observed in the 5–8 years age group only (41% vs. 18%). Rates of overweight and obesity increased with age across sexes. In youth, BMI standard deviation score was correlated with socio‐economic status, insulin regimen, blood pressure and blood lipids (P < 0.05). In adults, BMI was positively associated with blood pressure, and longer diabetes duration (P < 0.02). Conclusions Overweight and obesity are over‐represented in young persons with type 1 diabetes, particularly girls. As overweight is associated with other cardiovascular disease markers early intervention is paramount.

Insulin strategies for dietary fat and protein in type 1 diabetes: A systematic review

“…In practice, prior to adjusting the meal insulin strategy, it is important to address other potential causes of postprandial hyperglycaemia, including inaccuracies in carbohydrate counting, missed meal insulin doses, postprandial dosing, additional intake of food or drink as well as inaccuracies in the ICR and/ or the basal insulin dose. Furthermore, given the increased incidence of obesity 33,34 and risk of vascular complications 35,36 in this population, adjusting the insulin strategy for fat and fat and protein meals should always be discussed in the context of a healthful diet with individualised guidance around appropriate energy intake and physical activity.…”

The Double Whammy of Obesity and Diabetes on Female Reproductive Health

“…28 Young girls and women with T1DM appear to be more predisposed to weight gain, compared with their male counterparts. Weight gain in females with T1DM rises with age and duration of diabetes; importantly, the presence of obesity in this cohort is associated with at least one cardiovascular risk factor, 29 implying that weight gain may predispose to longterm metabolic complications. Intensive insulin therapy is now regarded as the standard of care for individuals with T1DM and has afforded a much improved outlook on mortality, morbidity, and fertility, via enhanced glycemic control.…”

Families' reports of problematic foods, management strategies and continuous glucose monitoring in type 1 diabetes: A cross‐sectional study

“…It is important that management strategies for problematic foods are discussed in the context of a balanced diet with individualised guidance around appropriate energy intake and physical activity to maintain BMI and waist circumference. 1 Recent research has shown that Australian children and adolescents with type 1 diabetes are more overweight and obese than their nondiabetic peers, [31][32][33] a trend that is mirrored internationally. 34,35 In type 1 diabetes, BMI increase has been strongly associated with female gender, as well as diabetes-specific factors including pubertal onset of diabetes, lower BMI at diabetes onset and longer duration of diabetes.…”