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Title: Obesity in youth with type 1 diabetes in Germany, Austria, and the United States

item DUBOSE, STEPHANIE - Jaeb Center For Health Research
item HERMANN, JULIA - Ulm University
item TAMBORLANE, WILLIAM - Yale University
item BECK, ROY - Jaeb Center For Health Research
item DOST, AXEL - University Of Jena
item HAYMOND, MOREY - Children'S Nutrition Research Center (CNRC)
item BACHA, FIDA - Children'S Nutrition Research Center (CNRC)

Submitted to: Journal of Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/22/2015
Publication Date: 9/1/2015
Citation: Dubose, S.N., Hermann, J.M., Tamborlane, W.V., Beck, R.W., Dost, A., DiMeglio, L.A., Schwab K.O., Holl, R.W., Hofer, S.E., Maahs, D.M. 2015. Obesity in youth with type 1 diabetes in Germany, Austria, and the United States. Journal of Pediatrics. 167(3):627-632.

Interpretive Summary: Obesity is now a common problem in children with type 1 diabetes, with prevalence similar to that in the general population. It is not known whether the overweight status of children with type 1 diabetes contributes to worse diabetes control or increased frequency of low blood sugar (hypoglycemia). In large national data sets (registries) from the US and Europe, data were examined to answer these questions. The analyses revealed that body mass index (BMI) was higher for youth with type 1 diabetes in the age groups of 6 to 17 years compared to peers from Europe. The greater BMI was related to worse diabetes control and more frequent occurrence of hypoglycemia. The results indicate that obesity is a common problem in children with type 1 diabetes, especially in the US and contributes to difficulty in diabetes control in these children.

Technical Abstract: 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). 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. 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. 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.