Hemoglobin A1c and body mass index in children and adolescents with IDDM. An observational study from 1976-1995

Summary:

In adult patients with type 1 diabetes good metabolic control was associated with an undesired weight gain. In the present report the possible association of HbA1c and body mass index (BMI) in children and adolescents with type 1 diabetes (IDDM) was investigated in a long-term retrospective study from 1976 to 1995. Further, the relationship between BMI on one hand and age, gender, duration of IDDM, the number of units of insulin used and the number of injections per day on the other hand were considered. Statistical analysis was performed using repeated measurements analyses of variance.

The 208 girls and 201 boys were 5-17 years old and had diabetes for beyond one year. For analysis 2512 data sets, in part measurements on the same patient in the course of the disease, were available. In various statistical models, the results show that age, gender, the daily amount of insulin, and the HbA1c level (p < 0.001-0.005) were associated with the BMI. Extremely high HbA1c levels coincided with a remarkably low BMI.

Hence, in children and adolescents with IDDM it may be difficult to achieve a constantly good metabolic control accompanied by a normal body weight.

Abbreviations: BMI = body mass index, z-score = SDS = standard deviation score, DCCT = Diabetes Control and Complications Trial

Key words:

HbA1c - BMI - insulin - children - adolescents

References

• 1 Bartz J, Sulzbach U, Heinze E, Teller W, Holl R W. Body composition in type 1 diabetes mellitus: bioimpedance measurements in 274 diabetic children, juveniles and young adults.  Dtsch Med Wschr. 122 815-819 1997; 
• 2 Carlson M G, Campell P. Intensive insulin therapy and weight gain in IDDM.  Diabetes. 42 1700-1707 1993; 
• 3 Danne T, Kordonouri O, Enders I, Weber B. Factors influencing height and weight development in children with Diabetes.  Diabetes Care. 20 281-285 1997; 
• 4 Despres J P, Moorjani S, Lupien P J, Tremblay A, Nadeau A, Bouchard C. Regional distribution of body fat, plasma lipoproteins and cardiovascular disease.  Artherosclerosis. 10 497-511 1990; 
• 5 Diabetes Control and Complications Trial Research Group . Effect of intensive diabetes treatment on the development and progression in adolescents with insulin-dependent mellitus: Diabetes Control and Complications Trial.  J Pediatr. 125 177-188 1994; 
• 6 Haffner S M, Stern M P, Hazuda H P, Pugh J, Patterson J K. Do upper-body and centralized adiposity measure different aspects of regional body-fat distribution? Relationship to non-insulin-dependent lipids and lipoproteins.  Diabetes. 36 43-51 1987; 
• 7 Heinze E, Vetter U, Thon A, Kohne E. Is there a risk-free haemoglobin A1 concentration in type 1 diabetics?.  Dtsch Med Wschr. 108 1632-1634 1983; 
• 8 Holl R W, Grabert M, Schweiggert F, Heinze E. Ein Computerprogramm zur prospektiven Datenerfassung bei jugendlichen Patienten mit Typ 1 Diabetes mellitus. Arbeitserleichterung, Qualitätskontrolle und Verbesserung der Kommunikation zwischen Diabeteszentrum, Hausarzt und Patient.  Diabetes und Stoffwechsel. 3 232-238 1993; 
• 9 Holl R W, Heinze E, Seifert M, Grabert M, Teller W M. Longitudinal analysis of somatic development in paediatric patients with IDDM: genetic influences on height and weight.  Diabetologia. 37 925-929 1994; 
• 10 Holl R W, Grabert M, Sorgo W, Heinze E, Debatin K M. Contributions of age, gender, and insulin administration to weight gain in subjects with IDDM.  Diabetologia. 41 542-547 1998; 
• 11 Komulainen J, Akerblom H K, Lounamaa R, Knip M. Prepubertal girls with insulin-dependent diabetes mellitus have higher exogenous insulin requirement than boys.  Eur J Pediatr. 157 708-711 1998; 
• 12 Larsson B, Svardsudd K, Welin L, Wilhelmsen I, Bjorntorp K P, Tibblin G. Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 years follow up of participants in the study of men born 1913.  Br Med J. 288 1401-1404 1984; 
• 13 Leiter L A. and the DCCT Research Group . Use of bioelectrical impedance analysis measurements in patients with diabetes.  Am J Clin Nutr. 64 (Suppl) 515-518 1996; 
• 14 Prader A, Largo R H, Molinari L, Issler C. Physical growth of Swiss children from birth to 20 years of age.  Helv Paediatr Acta. 52 (Suppl) 1-25 1989; 
• 15 Reichard P, Phil M. Mortality and treatment side-effects during long-term intensified conventional insulin treatment in the Stockholm Diabetes Intervention Study.  Diabetes. 43 313-317 1994; 
• 16 SAS Institute Inc., SAS/STAT Software .Changes and Enhancements through Release 6.11. First printing. SAS Institute Inc., Cary, NC pp. 531-656 1996
• 17 Sinha A, Formica C, Tsalamandris C, Panagiotopoulos S, Hendrich E, DeLuise M, Seeman E, Jerums G. Effects of insulin on body composition in patients with insulin-dependent and non-insulin-dependent diabetes.  Diab Med. 13 40-46 1995; 
• 18 The Diabetes Control and Complications Trial Research Group . The effect of intensive treatment of diabetes on the development of long-term complications in insulin-dependent diabetes mellitus.  N Engl J Med. 329 977-986 1993; 
• 19 Thon A, Heinze E, Feilen K D, Holl R W, Schmidt H, Koletzko S, Wendel U, Nothjunge J. Development of height and weight in children with diabetes mellitus: report on two prospective multicentre studies, one cross-sectional, one longitudinal.  Eur J Pediatr. 151 258-262 1992; 
• 20 Wing R R, Klein R, Moss S E. Weight gain associated with improved glycemic control in population-based sample of subjects with type 1 diabetes.  Diabetes Care. 13 1106-1109 1990;