Top

Published in:

01-12-2022 | Obesity | Research

Overweight/obesity in adolescents with type 1 diabetes belonging to an admixed population. A Brazilian multicenter study

Authors: Marilia Brito Gomes, Deborah Conte, Karla Rezende Guerra Drummond, Felipe Mallmann, André Araújo Pinheiro, Franz Schubert Lopes Leal, Paulo Henrique Morales, Carlos Antonio Negrato

Published in: Diabetology & Metabolic Syndrome | Issue 1/2022

Abstract

Background

To determine the prevalence of overweight/obesity and associated risk factors in Brazilian adolescents with type 1 diabetes (T1D) and its association with diabetic retinopathy (DR) and chronic kidney disease (CKD).

Methods

This study was performed in 14 Brazilian public clinics in ten cities, with 1,760 patients. 367 were adolescents (20.9%):184 females (50.1%), 176 (48.0%) Caucasians, aged 16.4 ± 1.9 years, age at diagnosis 8.9 ± 4.3 years, diabetes duration 8.1 ± 4.3 years, school attendance 10.9 ± 2.5 years and HbA1c 9.6 ± 2.4%.

Results

95 (25.9%) patients presented overweight/obesity, mostly females. These patients were older, had longer diabetes duration, higher levels of total and LDL-cholesterol, higher prevalence of family history of hypertension, hypertension, undesirable levels of LDL-cholesterol, and metabolic syndrome compared to eutrophic patients. No difference was found regarding ethnicity, HbA1c, uric acid, laboratorial markers of non-alcoholic fatty liver disease (alanine aminotransferase, aspartate aminotransferase, gamma-glutamyl transferase).

Conclusions

Almost one quarter of our patients presented overweight/obesity. These patients had higher prevalence of traditional risk factors for micro and macrovascular diabetes-related chronic complications such as diabetes duration, hypertension, high levels of LDL-cholesterol and metabolic syndrome. The majority of the patients with or without overweight/obesity presented inadequate glycemic control which is also an important risk factor for micro and macrovascular diabetes-related chronic complications. No association was found between overweight/obesity with diabetic CKD, DR and laboratorial markers of non-alcoholic fatty liver disease. The above-mentioned data point out that further prospective studies are urgently needed to establish the clinical prognosis of these young patients.

Pozzilli P, Guglielmi C, Caprio S, Buzzetti R. Obesity, autoimmunity, and double diabetes in youth. Diabetes Care. 2011;34(Suppl2):S166–70. https://doi.org/10.2337/dc11-s213.CrossRefPubMedPubMedCentral

Libman IM, Pietropaolo M, Arslanian SA, LaPorte RE, Becker DJ. Changing prevalence of overweight children and adolescents at onset of insulin-treated diabetes. Diabetes Care. 2003;26(10):2871–5. https://doi.org/10.2337/diacare.26.10.2871.CrossRefPubMed

Cleland SJ, Fisher BM, Colhoun HM, Sattar N, Petrie JR. Insulin resistance in type 1 diabetes: what is “double diabetes” and what are the risks? Diabetologia. 2013;56(7):1462–70. https://doi.org/10.1007/s00125-013-2904-2.CrossRefPubMedPubMedCentral

Giuffrida FM, Bulcão C, Cobas RA, Negrato CA, Gomes MB, Dib SA. Brazilian Type 1 Diabetes Study Group (BrazDiab1SG). Double-diabetes in a real-world sample of 2711 individuals: associated with insulin treatment or part of the heterogeneity of type 1 diabetes? Diabetol Metab Syndr. 2016;22(8):28. https://doi.org/10.1186/s13098-016-0143-7 (eCollection 2016).CrossRef

Teupe B, Bergis K. Epidemiological evidence for “double diabetes.” Lancet. 1991;337(8737):361–2. https://doi.org/10.1016/0140-6736(91)90988-2.CrossRefPubMed

Purnell JQ, Hokanson JE, Marcovina SM, Steffes MW, Cleary PA, Brunzell JD. Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: results from the DCCT Diabetes Control and Complications Trial. JAMA. 1998;280(2):140–6. https://doi.org/10.1001/jama.280.2.140.CrossRefPubMedPubMedCentral

Thorn LM, Forsblom C, Wadén J, Saraheimo M, Tolonen N, Hietala K, Groop PH. Finnish Diabetic Nephropathy (FinnDiane) Study Group Metabolic syndrome as a risk factor for cardiovascular disease, mortality, and progression of diabetic nephropathy in type 1 diabetes. Diabetes Care. 2009;32:950–2. https://doi.org/10.2337/dc08-2022 (Epub 2009 Feb 5).CrossRefPubMedPubMedCentral

Barros BSV, Monteiro FC, Terra C, Gomes MB. Prevalence of non-alcoholic fatty liver disease and its associated factors in individuals with type 1 diabetes: a cross-sectional study in a tertiary care center in Brazil. Diabetol Metab Syndr. 2021;13(1):33. https://doi.org/10.1186/s13098-021-00649-0.CrossRefPubMedPubMedCentral

Belete R, Ataro Z, Abdu A, Sheleme M. Global prevalence of metabolic Syndrome among patients with type I diabetes mellitus: a systematic review and meta-analysis. Diabetol Metab Syndr. 2021;13(1):25. https://doi.org/10.1186/s13098-021-00641-8.CrossRefPubMedPubMedCentral

10.

Chaturvedi N, Sjoelie AK, Porta M, Aldington SJ, Fuller JH, Songini M, Kohner EM. Markers of insulin resistance are strong risk factors for retinopathy incidence in type 1 diabetes EURODIAB Prospective Complications Study. Diabetes Care. 2001;24:284–9. https://doi.org/10.2337/diacare.24.2.284.CrossRefPubMed

11.

The DCCT Research Group. Weight gain associated with intensive therapy in the diabetes control and complications trial. Diabetes Care. 1998;11(7):567–73. https://doi.org/10.2337/diacare.11.7.567.CrossRef

12.

Fröhlich-Reiterer EE, Rosenbauer J, Bechtold-Dalla Pozza S, Hofer SE, Schober E, Holl RW, et al. Predictors of increasing BMI during the course of diabetes in children and adolescents with type 1 diabetes: data from the German/Austrian DPV multicentre survey. Arch Dis Child. 2014;99(8):738–43. https://doi.org/10.1136/archdischild-2013-304237.CrossRefPubMed

13.

Minges KE, Whittemore R, Weinzimer SA, Irwin ML, Redeker NS, Grey M. Correlates of overweight and obesity in 5529 adolescents with type 1 diabetes: The T1D Exchange Clinic Registry. Diabetes Res Clin Pract. 2017;126:68–78. https://doi.org/10.1016/j.diabres.2017.01.012.CrossRefPubMedPubMedCentral

14.

Gomes MB, Negrato CA. Adherence to insulin therapeutic regimens in patients with type 1 diabetes. A nationwide survey in Brazil. Diabetes Res Clin Pract. 2016;120:47–55. https://doi.org/10.1016/j.diabres.2016.07.011.CrossRefPubMed

15.

World Health Organization. Maternal, newborn, child and adolescent health/topics at a glance/adolescent health/Health for the world’s adolescents. (www.who.int; apps.who.int). Accessed in September 2019.

16.

IBGE Censo 2010. [Acessed in January,12,2020]. http://www.censo2010.ibge.gov.br.

17.

Davison KA, Negrato CA, Cobas R, Matheus A, Tannus L, Palma CS et al. Brazilian Type 1 Diabetes Study Group (BrazDiab1SG). Relationship between adherence to diet, glycemic control and cardiovascular risk factors in patients with type 1 diabetes: a nationwide survey in Brazil. Nutr J.2014; 13:19. doi: https://doi.org/10.1186/1475-2891-13-19

18.

American Diabetes Association. Clinical practice recommendations. Diabetes Care. 2021;44:S180-199.CrossRef

19.

Friedwald WT, Levy RI, Fredrickson DS. Estimations of serum low density lipoprotein cholesterol without use of preparative ultracentrifuge. Clin Chem. 1972;18(6):499–502 (PMID: 4337382).CrossRef

20.

World Health Organization. Obesity: preventing and managing the global epidemic. Report of a World Health Organization Consultation. Geneva: World Health Organization, 2000. p256. WHO Obesity Technical Report Series, n.284. PMID: 11234459

21.

Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3): e20171904. https://doi.org/10.1542/peds.2017-1904.CrossRefPubMed

22.

Gomes MB, de Mattos Matheus AS, Calliari LE, Luescher JL, Manna TD, Savoldelli RD, et al. Economic status and clinical care in young type 1 diabetes patients: a nationwide multicenter study in Brazil. Acta Diabetol. 2013;50(5):743–52. https://doi.org/10.1007/s00592-012-0404-3.CrossRefPubMed

23.

Instituto Brasileiro de Geografia e Estatística (IBGE). Censo 2000 [accessed in 2008 Aug.]. http:/www.ibge.gov.br/censo

24.

Malerbi DA, Franco LJ. Multicenter study of the prevalence of diabetes mellitus and impaired glucose tolerance in the urban Brazilian population aged 30–69 yr. The Brazilian Cooperative Group on the Study of Diabetes Prevalence. Diabetes Care. 1992;15(11):1509–16. https://doi.org/10.2337/diacare.15.11.1509.CrossRefPubMed

25.

ABEP. Brazilian Economic classification criteria, 2010 [accessed in 2008 aug]. http://www.abep.org/novo/Content.aspx?SectionID=84

26.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12. https://doi.org/10.7326/0003-4819-150-9-200905050-00006.CrossRefPubMedPubMedCentral

27.

Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol. 2009;4(11):1832–43. https://doi.org/10.2215/CJN.01640309.CrossRefPubMed

28.

Webster AC, Nagler EV, Morton RL, Masson P. Chronic kidney disease. Lancet. 2017;389(10075):1238–52. https://doi.org/10.1016/S0140-6736(16)32064-5.CrossRefPubMed

29.

Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical practice guideline for the evaluation and management of chronic kidney disease. In. Kidney.2013: Int Suppl 1–150.

30.

Wilkinson CP, Ferris FL 3rd, Klein RE, Lee PP, Agardh CD, Davis M, et al. Proposed international clinical diabetic retinopathy and diabetic macular edema disease severity scales. Ophthalmology. 2003;110(9):1677–82. https://doi.org/10.1016/S0161-6420(03)00475-5.CrossRefPubMed

31.

Alberti KGMM, Zimmet P, Shaw J, George K, Alberti MM, Aschner P, et al. Metabolic syndrome-a new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabetic Med. 2006;23(5):469–80. https://doi.org/10.1111/j.1464-5491.2006.01858.x.CrossRefPubMed

32.

IDF consensus definition of metabolic syndrome in children and adolescents .https://www.idf.org/, Accessed Jan 2020.

33.

Bell RA, Mayer-Davis EJ, Beyer JW, D’Agostino RB Jr, Lawrence JM, Linder B, Liu LL, Marcovina SM, Rodriguez BL, Williams D, Dabelea D, SEARCH for Diabetes in Youth Study Group. Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32(Suppl 2):S102–11. https://doi.org/10.2337/dc09-S202.CrossRefPubMedPubMedCentral

34.

Sistema de Vigilância Nutricional e Alimentar. Available from https://sisaps.saude.gov.br/sisvan/relatoriopublico/index. Acessed Feb 2021

35.

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–42. https://doi.org/10.1016/S0140-6736(17)32129-3.CrossRef

36.

van Vliet M, Van der Heyden JC, Diamant M, Von Rosenstiel IA, Schindhelm RK, Aanstoot HJ, et al. Overweight is highly prevalent in children with type 1 diabetes and associates with cardiometabolic risk. J Pediatr. 2010;156(6):923–9. https://doi.org/10.1016/j.jpeds.2009.12.017.CrossRefPubMed

37.

Schwab KO, Doerfer J, Marg W, Schober E, Holl RW, DPV Science Initiative and the Competence Network Diabetes mellitus. Characterization of 33 488 children and adolescents with type 1 diabetes based on the gender-specific increase of cardiovascular risk factors. Pediatr Diabetes. 2010;11(5):357–63. https://doi.org/10.1111/j.1399-5448.2010.00665.x.CrossRefPubMed

38.

Flechtner-Mors M, Schwab KO, Fröhlich-Reiterer EE, Kapellen TM, Meissner T, Rosenbauer J, et al. Overweight and obesity based on four reference systems in 18,382 paediatric patients with type 1 diabetes from Germany and Austria. J Diabetes Res. 2015;2015: 370753. https://doi.org/10.1155/2015/370753.CrossRefPubMedPubMedCentral

39.

Liu LL, Lawrence JM, Davis C, Liese AD, Pettitt DJ, Pihoker C, et al. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study. Pediatr Diabetes. 2010;11(1):4–11. https://doi.org/10.1111/j.1399-5448.2009.00519.x.CrossRefPubMed

40.

Gomes MB, Gabrielli AB, Santos DC, Pizarro MH, Barros BSV, Negrato CA, et al. Self-reported color-race and genomic ancestry in an admixed population: a contribution of a nationwide survey in patients with type 1 diabetes in Brazil. Diabetes Res Clin Pract. 2018;140:245–52. https://doi.org/10.1016/j.diabres.2018.03.021 (Epub 2018 Mar 21).CrossRefPubMed

41.

Alvarez MM, Vieira ACRE, Sichieri R, da Veiga GV. Prevalence of metabolic syndrome and of its specific components among adolescents from Niterói City, Rio de Janeiro State. Brazil Arq Bras Endocrinol Metabol. 2011;55(2):164–70. https://doi.org/10.1590/S0004-27302011000200009.CrossRefPubMed

42.

Davis TME, Bruce DG, Davis WA. Prevalence and prognostic implications of the metabolic syndrome in community-based patients with type 1 diabetes: The Fremantle Diabetes Study. Diabetes Res Clin Pract. 2007;78(3):412–7. https://doi.org/10.1016/j.diabres.2007.06.007.CrossRefPubMed

43.

de Melo LGN, Morales PH, Drummond KRG, Santos DC, Haas Pizarro M, Barros BSV, et al. Prevalence and risk factors for referable diabetic retinopathy in patients with type 1 diabetes: a nationwide study in Brazil. Acta Ophthalmol. 2018;96(8):e1032–3. https://doi.org/10.1111/aos.13760.CrossRefPubMed

44.

Gomes MB, Pizarro MH, Muniz LH, Barros BSV, Melo LGN, Santos DC, et al. Prevalence of chronic kidney disease in an admixed population of patients with type 1 diabetes. A multicenter study in Brazil. Diabetes Res Clin Pract. 2020;170:108490. https://doi.org/10.1016/j.diabres.2020.108490.CrossRefPubMed

45.

Petitti DB, Imperatore G, Pall AL, Daniels SR, Dollan LM, Kershnar AK, Marcovina S, et al. Serum lipids and glucose control. Arch Pediatr Adolesc Med. 2007;161(2):159–65. https://doi.org/10.1001/archpedi.161.2.159.CrossRefPubMed

46.

Özcan B, Delhanty PJD, Huisman M, Visser JA, Neggers SJ, van der Lely AJ. Overweight and obesity in type 1 diabetes is not associated with higher ghrelin concentrations. Diabetol Metab Syndr. 2021;13(1):79. https://doi.org/10.1186/s13098-021-00699-4.CrossRefPubMedPubMedCentral

47.

Khan AS, McLoughney CR, Ahmed AB. The effect of metformin on blood glucose control in overweight patients with type 1 diabetes. Diabet Med. 2006;23(10):1079–84. https://doi.org/10.1111/j.1464-5491.2006.01966.x.CrossRefPubMed

48.

Jacobsen IB, Henriksen JE, Beck-Nielsen H. The effect of metformin in overweight patients with type 1 diabetes and poor metabolic control. Basic Clin Pharmacol Toxicol. 2009;105(3):145–9. https://doi.org/10.1111/j.1742-7843.2009.00380.x.CrossRefPubMed

Title: Overweight/obesity in adolescents with type 1 diabetes belonging to an admixed population. A Brazilian multicenter study
Authors: Marilia Brito Gomes
Deborah Conte
Karla Rezende Guerra Drummond
Felipe Mallmann
André Araújo Pinheiro
Franz Schubert Lopes Leal
Paulo Henrique Morales
Carlos Antonio Negrato
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Obesity
Obesity
Diabetic Retinopathy
Insulins
Diabetic Retinopathy
Overweight
Insulins
Type 1 Diabetes
Published in: Diabetology & Metabolic Syndrome / Issue 1/2022
Electronic ISSN: 1758-5996
DOI: https://doi.org/10.1186/s13098-021-00759-9

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Overweight/obesity in adolescents with type 1 diabetes belonging to an admixed population. A Brazilian multicenter study

Abstract

Background

Methods

Results

Conclusions

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2022

Fibrinogen function indexes are potential biomarkers for evaluating the occurrence and severity of diabetic foot

Impact of diabetes mellitus on outcomes of patients with sepsis: an updated systematic review and meta-analysis

Is compromised intestinal barrier integrity responsible for the poor prognosis in critically ill patients with pre-existing hyperglycemia?

Effect of low-dose tadalafil once daily on glycemic control in patients with type 2 diabetes and erectile dysfunction: a randomized, double-blind, placebo-controlled pilot study

Effectiveness of a nurse practitioner-led cardiovascular prevention clinic at reduction of metabolic syndrome following maternal complications of pregnancy: a preliminary analysis

The effectiveness of an intervention designed based on health action process approach on diet and medication adherence among patients with type 2 diabetes: a randomized controlled trial

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page