Issue 112 Item 16 Risk for Type 1 Diabetes Greater in Overweight Children

A disturbing rise in the incidence of overweight children has occurred along with an increase of type 1 diabetes. In recent decades, the incidence of type 1 diabetes (DM1) in developed countries has increased for children under age 15 in general, but mostly in younger children, as reported by EURODIAB. Concurrently, a disturbing rise in the incidence of overweight children has occurred.

We therefore searched computer and clinic records of all pediatric patients diagnosed with DM1 between 1.1.98 and 12.31.01, and examined body mass index (BMI) at diagnosis (Dx), and by <3 months post-diagnosis (P-Dx) reflecting body habitus prior to any weight loss. BMI Z-scores (BMIZ) for age >2 years, were calculated per CDC 2000 data. We included patients from physicians who admit all of their newly diagnosed diabetics to Children’s Hospital of San Diego, and all DM1 patients cared for at Kaiser Permanente in San Diego. Patients from physicians who primarily admit younger or sicker patients with DM1 were excluded, as were non-resident patients.

Also, we excluded obese patients initially treated as type 2, based on c-peptide, and clinical phenotype, who had DM1antibodies, and later became insulinopenic. Of 289 patients <15 years old (yr) in age groups 0-4, 5-9, and 10-14, there were 26.0%, 35.3%, and 38.7%, respectively. Distrbution by gender was 29.9%, 34.3%, and 35.8% in 137 girls, and 22.4%, 36.2%, and 41.4% in 152 boys, in the respective age groups. Mean (SD)[%] BMIZ at Dx and P-Dx were respectively -0.61 (1.6)[27%] and 1.09 (0.78)[86%] for ages 2-4, 0.03 (1.4)[51%] and 0.89 (1.0)[82%] for ages 5-9, -0.3 (1.2)[38%] and 0.64 (0.8)[74%] for ages 10-14. Height Z-score was about 0.25 for the 3 age groups [60%]. Mean weight gain was 15.2%, 12.5%, and 14.9%, respectively. Of all 321 pediatric patients <19 yr [1.2:1 M:F], 62.1% were Caucasian, 23.6% Hispanic, 3.4% African American, 2.5% Other, 0.9% Asian, 7.5% mixed ethnicities. BMIZ post-Dx was 1.09 in Hispanics and 0.7 in Caucasians (p <0.05). Mean weight for height P-Dx was at 80% for patients <2yr. Mean BMIZ are high P-Dx compared to expected BMIZ=0 (p <0.0001) in ages 2 to <15 yr, even though P-Dx BMI Z-scores may be underestimated, since in some cases we only had P-Dx data at <10 days. BMIZ correlated negatively with age of Dx in ages 2 to <15 yr, with r = -0.22 (spearman,p <0.001), and was significantly higher than BMIZ in 10-14 yr (p=0.01).

Conclusions: Age of Dx of DM1 no longer shows a prominent peak after age 10.

Overweight may increase the risk of developing type1 diabetes, especially in younger children. Endo 2002 [P2-357] The Changing Epidemiology of Childhood Type 1 Diabetes and the Obesity Epidemic