Assessment of metabolic status in adolescents with type 1 diabetes: the utility of the SPISE index

Mert Ucar; Didem Guneş Kaya; İlayda Altun; Hasan Karakaş; Gokce Velioğlu Haşlak; Abdurrahman Guney; Elvan Bayramoğlu; Olcay Evliyaoglu; Hande Turan

doi:10.1530/endoabs.110.P9

JOINT1924

Background and objectives: Body mass index(BMI) has limitations in assessing metabolic status in adolescents. Insulin-based methods are not applicable in patients with type 1 diabetes(T1D). The SPISE index, calculated using BMI, HDL, and triglyceride levels, has been proposed as a potential tool for monitoring metabolic status in adolescents with T1D. This study aimed to evaluate the efficacy of the SPISE index in assessing metabolic status in this population.

Methods: A total of 83 adolescents(aged 12–18 years, Tanner stage 5) with T1D for at least one year were included. Participants were categorized into three groups: underweight(UW:BMI SDS<−1), normal(NW:−1<BMI SDS<1), and overweight(OW:BMI SDS>1). Baseline anthropometric measurements, daily insulin doses, HbA1c levels, lipid profiles, and body fat percentages (BFP) by bioelectrical impedance were noted. The SPISE index(SPISE=600xHDL^0.185/(Triglyceride^0.2xBMI^1.338)) was also used to assess the metabolic status. Standardized diet and exercise recommendations were provided, and all parameters were re-evaluated after 12 months.

Result: The study included 24(28.9%) underweight,36(43.4%) normal, and 23(27.7%) overweight participants. The median age was 15.7(14.4;17) years, and the median duration of diagnosis was 4.1(3.1;6.1)years. The age, gender and insulin delivery mode distributions were similar between the groups. The baseline and follow-up metabolic parameters of the groups are presented in Table 1. Notably, BFP and triglyceride levels in the UW group were found to have significantly increased compared to the OW. The SPISE index levels significantly decreased in both UW and NW groups compared to the OW group. Despite the absence of significant differences in HbA1c and daily insulin doses, deterioration in metabolic control was observed in UW and NW groups. Finally, linear regression analysis found a significant negative correlation between the BFP and the SPISE index in (P=0.001, R²=0.26).


	Baseline(0.month)			Control(12.month)
	Underweight	Normal	Overweight	Underweight	Normal	Overweight	P value
BMI S.D.	−1.67±0.6	0.1±0.55	1.71±0.56	−1.4±0.98	0.22±0.73	1.61±0.88	0.86
Body Fat(%)	17.86±6.37	20.9±4.2	29.45± 6.5	19.6 ± 6.6	22.2±7.3	28.7± 8.2	0.03
Total Insulin (IU/kg/day)	0.87±0.27	0.94±0.27	1.05±0.34	0.94±0.29	0.99±0.34	1.1±0.33	0.70
Basal Insulin (IU/kg/day)	0.37±0.12	0.41±0.12	0.46±0.15	0.4±0.11	0.42±0.13	0.47±0.14	0.71
HbA1c(%)	7.78±1.19	8.1±1.95	8.2 ±1.7	8.1±1.58	8.5±1.9	8.5±1.64	0.40
HDL(mg/dl)	58.6±11	58.7±13	61± 19.8	55.8± 12.6	57.4±15.3	56.8±12.2	0.94
LDL(mg/dl)	89.8± 21	91±26.7	96.9±28.5	92.8±23	89.6±20.2	96.5±24.3	0.78
Triglycerides (mg/dl)	80.5±43	84±36.3	106.8±54.5	90 ±38	87.7±34	82.6±40	0.04
SPISE Index	12.3±2.1	9.44±1.8	6.5±1.4	11±2.3	8.7±1.8	6.7±1.4	0.001

Conclusion: Monitoring the SPISE index may provide a more comprehensive assessment of metabolic status in adolescents with T1D. However, larger longitudinal studies are needed to validate its predictive value for future complications.

Endocrine Abstracts

P9