Endocrine Abstracts

Background: Previous studies have reported that increased BMI and increase in insulin requirement are associated with more rapid disease progression following diagnosis in type 1 diabetes mellitus (T1DM). The recent UK National Paediatric Diabetes Audit (NPDA) 2013/14 reported that 37% of 0–11 year old children and 44% of 12 years and older children are currently overweight or obese.

Objective: Our objective was to evaluate factors associated with increased BMI SDS in CYP with T1DM following diagnosis.

Method: We examined the insulin requirement profiles defined by total daily insulin dose per kilogram body weight, BMI SDS, mean HbA1C over 12 months, age at diagnosis and pubertal status of 102 CYP with T1DM between April 2014 to March 2015 in a single paediatric centre.

Results: There were 59 males. 42 were on continuous subcutaneous insulin infusion (CSII), 56 were on multiple daily insulin regimen and four were on twice daily insulin regimen. Mean age at diagnosis was 7.79 years (range 0.16–16.91), mean BMI SDS was 0.89 (range −3.7 to +3.32), mean height SDS was 0.02±2.97 and mean weight SDS was 0.73±3.75. Mean diastolic blood pressure was 69 mm Hg (range 51–89), mean insulin requirement was 1.01 units/kg per day (range 0.38–2.43) and mean HbA1C was 8.0 (range 5.3–13.4). Out of 102 CYP, 24 were pre-pubertal, 28 were pubertal and 50 were post-pubertal. There was significant positive correlation between increased insulin requirement (units/kg per day) and HbA1c (r=0.59, P<0.01) and significant positive correlation between insulin requirement (units/kg per day) and BMI SDS (r=0.23, P=0.02). BMI SDS was not correlated with HbA1c. Multivariable linear regression analysis of factors affecting BMI SDS (age at diagnosis, HbA1c, gender, pubertal status and insulin in units/kg per day) showed that increased insulin requirement was a single independent factor affecting BMI SDS.

Conclusion: There is a significant relationship between increased total insulin requirement (units/kg per day) and increased BMI SDS in CYP with T1DM. Higher insulin requirement was also associated with poorer metabolic control following diagnosis