Abstract: SUN 003

Increased Body Mass Index Correlates with Higher C-Peptide Serum Levels and a Younger Age of Onset in Children with Type 1 Diabetes Mellitus

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Abstract


Background
Classically, children with T1DM have been considered to be completely insulin deficient, yet some of them will still exhibit residual beta-cell function when diagnosed. The amount of the remaining insulin secretion as well as the degree of beta-cell loss differs among patients.
Hypothesis
Obese and overweight children could have T1DM onset earlier despite the evidence of remaining beta-cell secretion.
Methods view more

Background
Classically, children with T1DM have been considered to be completely insulin deficient, yet some of them will still exhibit residual beta-cell function when diagnosed. The amount of the remaining insulin secretion as well as the degree of beta-cell loss differs among patients.
Hypothesis
Obese and overweight children could have T1DM onset earlier despite the evidence of remaining beta-cell secretion.
Methods
We performed a retrospective analysis that included children from 1 to 13 years of age diagnosed with T1DM between 2012 and 2015. T1DM was defined by the presence of at least one diabetes autoantibody (anti-GAD or anti-insulin antibody) and treatment with either insulin pump or at least four daily injections of insulin one year after onset.
Results
We analyzed 148 new cases of T1DM. The mean age of diagnosis was 8.7 ± 3.0 years and 52.7% were males. Patients’ distribution according to BMI percentiles consisted of: low weight (19.6%), normal weight (60.1%), overweight (9.5%) and obese (10.8%); among these groups the mean age of diagnosis was 8.8, 8.9, 9.3 and 6.8 years, respectively.
For patients older than 7 years of age, we found a negative linear correlation between the age of onset and the percentile of BMI (r=-0.21, p=0.03). Moreover, we also determined that for the whole sample, an increasing age showed a reduced probability of being obese (OR 0.79, 95% CI: 0.66-0.95). Upon multivariate linear regression we were able to establish that serum C-peptide levels were significantly higher in patients with higher BMI percentiles (p=0.013) and older age of onset (p<0.001), even after adjusting for sex and serum levels of HbA1C.
Discussion
We illustrated how excess weight might hasten the manifestations of preexisting autoimmune beta-cell damage. Additionally, children who were overweight or obese demonstrated increased residual beta-cell function at the moment of diagnosis. Children with some degree of insulin resistance bear possible interactions between hyperglycemia and lipotoxicity that could eventually trigger or accelerate beta-cell apoptosis. Thus, strategies aimed at reducing the loss of residual beta-cell mass in overweight or obese children are required.
Disclosures of potential conflicts of interest.
The authors declare no conflicts of interest.

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