Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States

Stephanie N. Dubose, Julia M. Hermann, William V. Tamborlane, Roy W. Beck, Axel Dost, Linda DiMeglio, Karl Otfried Schwab, Reinhard W. Holl, Sabine E. Hofer, David M. Maahs

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Abstract

Objective 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). Study design 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. Results 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. Conclusions 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.

Original languageEnglish
Pages (from-to)627-632.e4
JournalJournal of Pediatrics
Volume167
Issue number3
DOIs
StatePublished - Sep 1 2015

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Austria
Type 1 Diabetes Mellitus
Germany
Obesity
Registries
Body Mass Index
Hypoglycemia
Hemoglobins
Age Groups
Centers for Disease Control and Prevention (U.S.)
Reference Values
Interviews
Pediatrics
Weights and Measures
Health

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Dubose, S. N., Hermann, J. M., Tamborlane, W. V., Beck, R. W., Dost, A., DiMeglio, L., ... 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.e4. https://doi.org/10.1016/j.jpeds.2015.05.046

Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States. / Dubose, Stephanie N.; Hermann, Julia M.; Tamborlane, William V.; Beck, Roy W.; Dost, Axel; DiMeglio, Linda; Schwab, Karl Otfried; Holl, Reinhard W.; Hofer, Sabine E.; Maahs, David M.

In: Journal of Pediatrics, Vol. 167, No. 3, 01.09.2015, p. 627-632.e4.

Research output: Contribution to journalArticle

Dubose, SN, Hermann, JM, Tamborlane, WV, Beck, RW, Dost, A, DiMeglio, L, Schwab, KO, Holl, RW, Hofer, SE & Maahs, DM 2015, 'Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States', Journal of Pediatrics, vol. 167, no. 3, pp. 627-632.e4. https://doi.org/10.1016/j.jpeds.2015.05.046
Dubose, Stephanie N. ; Hermann, Julia M. ; Tamborlane, William V. ; Beck, Roy W. ; Dost, Axel ; DiMeglio, Linda ; Schwab, Karl Otfried ; Holl, Reinhard W. ; Hofer, Sabine E. ; Maahs, David M. / Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States. In: Journal of Pediatrics. 2015 ; Vol. 167, No. 3. pp. 627-632.e4.
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abstract = "Objective 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). Study design 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. Results 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. Conclusions 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.",
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AU - Hermann, Julia M.

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AU - Dost, Axel

AU - DiMeglio, Linda

AU - Schwab, Karl Otfried

AU - Holl, Reinhard W.

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N2 - Objective 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). Study design 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. Results 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. Conclusions 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.

AB - Objective 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). Study design 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. Results 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. Conclusions 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.

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