Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States - 26/08/15

Doi : 10.1016/j.jpeds.2015.05.046

Stephanie N. DuBose, MPH ^1,^⁎ , Julia M. Hermann, MS ², William V. Tamborlane, MD ³, Roy W. Beck, MD, PhD ¹, Axel Dost, MD ⁴, Linda A. DiMeglio, MD, MPH ⁵, Karl Otfried Schwab, MD ⁶, Reinhard W. Holl, MD ², Sabine E. Hofer, MD ^7,^{^{∗
Contributed equally.}}, David M. Maahs, MD, PhD ^8,^{^{∗
Contributed equally.}}
on behalf of the
Type 1 Diabetes Exchange Clinic Network and Diabetes Prospective Follow-up Registry^{^†}
List of members of T1D Exchange Clinic Network and Diabetes Prospective Follow-up Registry study group members is available at www.jpeds.com (Appendix).
Steven Willi, Terri Lipman, Tammy Calvano, Olena Kucheruk, Pantea Minnock, Chau Nguyen, Georgeanna Klingensmith, Carolyn Banion, Jennifer Barker, Cindy Cain, Peter Chase, Sandy Hoops, Megan Kelsy, Georgeanna Klingensmith, David Maahs, Cathy Mowry, Kristen Nadeau, Jennifer Raymond, Marian Rewers, Arleta Rewers, Robert Slover, Andrea Steck, Paul Wadwa, Philippe Walravens, Philip Zeitler, Heidi Haro, Katherine Manseau, Ruth Weinstock, Roberto Izquierdo, Umair Sheikh, Patricia Conboy, Jane Bulger, Suzan Bzdick, Robin Goland, Rachelle Gandica, Lindsay Weiner, Steve Cook, Ellen Greenberg, Kevin Kohm, Sarah Pollack, Joyce Lee, Brigid Gregg, Meng Tan, Kimberly Burgh, Ashley Eason, Satish Garg, Aaron Michels, Lisa Myers, Linda DiMeglio, Tamara Hannon, Donald Orr, Christy Cruz, Stephanie Woerner, Joseph Wolfsdorf, Maryanne Quinn, Olivia Tawa, Andrew Ahmann, Jessica Castle, Farahnaz Joarder, Chris Bogan, Nancy Cady, Jennifer Cox, Amy Pitts, Rebecca Fitch, Brad White, Bethany Wollam, Bruce Bode, Katie Lindmark, RaShonda Hosey, Kathleen Bethin, Teresa Quattrin, Michelle Ecker, Jamie Wood, Lily Chao, Clement Cheung, Lynda Fisher, Debra Jeandron, Francine Kaufman, Mimi Kim, Brian Miyazaki, Roshanak Monzavi, Payal Patel, Pisit Pitukcheewanont, Anna Sandstrom, Marisa Cohen, Brian Ichihara, Megan Lipton, Ayse Cemeroglu, Yaw Appiagyei-Dankah, Maala Daniel, Daniel Postellon, Michael Racine, Michael Wood, Lora Kleis, Irl Hirsch, Anthony DeSantis, D.C. Dugdale, R. Alan Failor, Lisa Gilliam, Carla Greenbaum, Mary Janci, Peggy Odegard, Dace Trence, Brent Wisse, Emily Batts, Angela Dove, Deborah Hefty, Dori Khakpour, Jani Klein, Kristen Kuhns, Marli McCulloch-Olson, Christina Peterson, Mary Ramey, Marissa St. Marie, Pam Thomson, Christine Webber, David Liljenquist, Mark Sulik, Carl Vance, Tiffany Coughenour, Chris Brown, Jean Halford, Andrea Prudent, Shanda Rigby, Brandon Robison, Harold Starkman, Tymara Berry, Barbara Cerame, Daisy Chin, Laurie Ebner-Lyon, Frances Guevarra, Kristen Sabanosh, Lawrence Silverman, Christine Wagner, Marie Fox, Bruce Buckingham, Avni Shah, Kimberly Caswell, Breanne Harris, Richard Bergenstal, Amy Criego, Greg Damberg, Glenn Matfin, Margaret Powers, David Tridgell, Cassie Burt, Beth Olson, LeeAnn Thomas, Sanjeev Mehta, Michelle Katz, Lori Laffel, Joanne Hathway, Roxanne Phillips, Eda Cengiz, William Tamborlane, Darryll Cappiello, Amy Steffen, Melinda Zgorski, Anne Peters, Valerie Ruelas, Robert Benjamin, Deanna Adkins, Juanita Cuffee, Amber Spruill, Richard Bergenstal, Amy Criego, Greg Damberg, Glenn Matfin, Margaret Powers, David Tridgell, Cassie Burt, Beth Olson, LeeAnn Thomas, Grazia Aleppo-Kacmarek, Teresa Derby, Elaine Massaro, Kimberly Webb, Christine Burt Solorzano, Mark DeBoer, Helen Madison, Janet McGill, Lori Buechler, Mary Jane Clifton, Stacy Hurst, Sarah Kissel, Carol Recklein, Eva Tsalikian, Michael Tansey, Joanne Cabbage, Julie Coffey, Sarah Salamati, Mark Clements, Sripriya Raman, Angela Turpin, Jennifer Bedard, Cyndy Cohoon, Aliza Elrod, Amanda Fridlington, Lois Hester, Davida Kruger, Desmond Schatz, Michael Clare-Salzler, Kenneth Cusi, Colleen Digman, Becky Fudge, Mike Haller, Collette Meehan, Henry Rohrs, Janet Silverstein, Sujata Wagh, Miriam Cintron, Eleni Sheehan, Jamie Thomas, Mark Daniels, Susan Clark, Timothy Flannery, Nikta Forghani, Ajanta Naidu, Christina Reh, Peggy Scoggin, Lien Trinh, Natalie Ayala, Rebeca Quintana, Heather Speer, William Zipf, Diane Seiple, Julie Kittelsrud, Ashutosh Gupta, Vikki Peterson, Ashley Stoker, Michael Gottschalk, Marla Hashiguchi, Katheryn Smith, Henry Rodriguez, Craig Bobik, Danielle Henson, Jill Simmons, Amy Potter, Margo Black, Faith Brendle, Rose Gubitosi-Klug, Beth Kaminski, Susan Bergant, Wendy Campbell, Catherine Tasi, Kenneth Copeland, Joni Beck, Joane Less, Jill Schanuel, Jennifer Tolbert, Saleh Adi, Andrea Gerard-Gonzalez, Stephen Gitelman, Nassim Chettout, Christine Torok, Catherine Pihoker, Joyce Yi-Frazier, Susan Kearns, Ingrid Libman, Vicky Bills, Ana Diaz, Julie Duke, Brandon Nathan, Antoinette Moran, Melena Bellin, Shannon Beasley, Anne Kogler, Janice Leschyshyn, Kara Schmid, Anne Street, Bryce Nelson, Carrie Frost, Erin Reifeis, Morey Haymond, Fida Bacha, Maria Caldas-Vasquez, Sara Klinepeter, Maria Redondo, Rosa Berlanga, Teresa Falk, Elizabeth Garnes, Janette Gonzalez, Cecilia Martinez, Mariam Pontifes, Ronald Yulatic, Kathleen Arnold, Traci Evans, Sharon Sellers, Vandana Raman, Carol Foster, Mary Murray, Vandana Raman, Trina Brown, Hillarie Slater, Karen Wheeler, David Harlan, Mary Lee, John-Paul Lock, Celia Hartigan, Lisa Hubacz, John Buse, Ali Calikoglu, Joseph Largay, Laura Young, Helen Brown, Vinnie Duncan, Michelle Duclos, Julie Tricome, Verdayne Brandenburg, Julie Blehm, Julie Hallanger-Johnson, Dawn Hanson, Corliss Miller, Jennifer Weiss, Robert Hoffman, Monika Chaudhari, David Repaske, Elizabeth Gilson, Jesse Haines, Justen Rudolph, Charles McClave, Doris Biersdorf, Anthony Tello, Julie Blehm, Donna Amundson, Rhonda Ward, Michael Rickels, Cornelia Dalton-Bakes, Eileen Markman, Amy Peleckis, Nora Rosenfeld, Lawrence Dolan, Sarah Corathers, Jessica Kichler, Holly Baugh, Debbie Standiford, Jeanne Hassing, Jennifer Jones, Stephen Willis, Stephen Willis, Carol Wysham, Lisa Davis, Scott Blackman, Kimber-Lee Abel, Loretta Clark, Andrea Jonas, Ellie Kagan, Jay Sosenko, Carlos Blashke, Della Matheson, Rachel Edelen, Thomas Repas, Denise Baldwin, Trista Borgwardt, Christina Conroy, Kelly DeGrote, Rod Marchiando, Michelle Wasson, Larry Fox, Nelly Mauras, Ligeia Damaso, Kim Englert, Marwan Hamaty, Laurence Kennedy, Michelle Schweiger, Pantelis Konstantinopoulos, Carolyn Mawhorter, Amy Orasko, Denise Rose, Larry Deeb, Kim Rohrbacher, Leroy Schroeder, Amanda Roark, Omar Ali, Joanna Kramer, Donna Whitson-Jones, Amy Potter, Margo Black, Faith Brendle, Heidi Gassner, Sobha Kollipara, Vicky Bills, Julie Duke, Katerina Harwood, Vijaya Prasad, Judy Brault

¹ Jaeb Center for Health Research, Tampa, FL
² Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
³ Yale University, New Haven, CT
⁴ Department of Pediatrics, University Children's Hospital Jena, Jena, Germany
⁵ Indiana University School of Medicine, Indianapolis, IN
⁶ University Children's Hospital Freiburg, Freiburg, Germany
⁷ Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
⁸ Barbara Davis Center for Childhood Diabetes, Aurora, CO

^∗Reprint requests: Stephanie N. DuBose, MPH, Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647.

Abstract

Objective

To examine the current extent of the obesity problem in 2 large pediatric clinical registries in the US and Europe and to examine the hypotheses that increased body mass index (BMI) z-scores (BMIz) are associated with greater hemoglobin A1c (HbA1c) and increased frequency of severe hypoglycemia in youth with type 1 diabetes (T1D).

Study design

International (World Health Organization) and national (Centers for Disease Control and Prevention/German Health Interview and Examination Survey for Children and Adolescents) BMI references were used to calculate BMIz in participants (age 2-<18 years and ≥1 year duration of T1D) enrolled in the T1D Exchange (n = 11 435) and the Diabetes Prospective Follow-up (n = 21 501). Associations between BMIz and HbA1c and severe hypoglycemia were assessed.

Results

Participants in both registries had median BMI values that were greater than international and their respective national reference values. BMIz was significantly greater in the T1D Exchange vs the Diabetes Prospective Follow-up (P < .001). After stratification by age-group, no differences in BMI between registries existed for children 2-5 years, but differences were confirmed for 6- to 9-, 10- to 13-, and 14- to 17-year age groups (all P < .001). Greater BMIz were significantly related to greater HbA1c levels and more frequent occurrence of severe hypoglycemia across the registries, although these associations may not be clinically relevant.

Conclusions

Excessive weight is a common problem in children with T1D in Germany and Austria and, especially, in the US. Our data suggest that obesity contributes to the challenges in achieving optimal glycemic control in children and adolescents with T1D.

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Keyword : BMI, BMIz, CDC, DCCT, DPV, EDIC, HbA1c, IRB, KiGGS, T1D, T1DX, WHO

Plan

Supported by the Leona M. and Harry B. Helmsley Charitable Trust, and the German Federal Ministry of Education and Research Competence Net Diabetes Mellitus (which is integrated into the German Center for Diabetes Research as of January 2015; FKZ 01GI1106), and the European Foundation for the Study of Diabetes. The authors declare no conflicts of interest.

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Vol 167 - N° 3

P. 627 - septembre 2015 Retour au numéro

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Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States - 26/08/15

Abstract

Objective

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Plan

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