Journal
DIABETES RESEARCH AND CLINICAL PRACTICE
Volume 100, Issue 1, Pages 126-132Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.diabres.2012.12.025
Keywords
BMI; Children; Adolescents; Longitudinal
Categories
Funding
- NIH
- Eunice Kennedy Shriver National Institute of Child Health and Human Development [s N01-HD-3-3360]
- Children's Memorial Hospital, Chicago, Illinois [N01-HD-4-3363]
- Texas Children's Hospital, Houston, Texas [N01-HD-4-3362]
- Nemours Children's Clinic, Jacksonville, Florida [N01-HD-4-3361]
- Joslin Diabetes Center, Boston, Massachusetts [N01-HD-4-3364]
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Aims: Weight gain is an oft-cited outcome of improved glycemic control in adults with type 1 diabetes, though few studies have investigated this in youth. The purpose of this paper was to examine cross-sectional and longitudinal associations of body mass index (BMI, kg/m(2)) with glycemic control in youth with type 1 diabetes (n = 340, 12.5 +/- 1.7 year, 49% female, duration >= 1 year) participating in a 2-year multi-center intervention study targeting family diabetes management. Methods: BMI was calculated from height and weight measured at clinic visits. Glycohemoglobin (HbA1c) at each visit was assayed centrally. Cross-sectional associations of baseline BMI with glycemic control, and of change in BMI and HbA1c with baseline values, were examined. Longitudinal associations of time-varying BMI and HbA1c were examined using a multilevel linear mixed effects model controlling for time-varying time (months), insulin dose (units/kg/day), regimen, Tanner stage, and time invariant baseline diabetes duration, BMI, treatment group and sociodemographic characteristics. Results: Baseline HbA1c was unrelated to baseline BMI, but was related positively to subsequent BMI change (p = 0.04) and inversely to HbA1c change (p = 0.002). Baseline BMI was inversely related to BMI change (p = 0.01) and unrelated to HbA1c change. In multilevel regression, BMI was related inversely to HbA1c (%) (beta +/- SE = -0.11 +/- 0.02, p < 0.001) and positively to insulin dose (0.23 +/- 0.07, p = 0.001). In the treatment group only, BMI was positively related to pump regimen (0.18 +/- 0.08, p = 0.02). Conclusions: Increased insulin administered to improve glycemic control may contribute to increased BMI in youth with type 1 diabetes, indicating the importance of determining ways to minimize weight gain while optimizing glycemic control. Published by Elsevier Ireland Ltd.
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