Abdominal adiposity and cardiovascular risk factors in adolescents with type 1 diabetes

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Abstract

Aim

To analyze the prevalence of abdominal adiposity and other traditional risk factors for cardiovascular disease in a large sample of Italian adolescents with type 1 diabetes mellitus (T1DM).

Methods

T1DM adolescents (n = 412 age: 17.3 ± 0.9 years) were enrolled from 18 clinical centres. Anthropometric and laboratory parameters, blood pressure and data on insulin treatment were registered. Metabolic syndrome (MetSy) was defined according to the International Diabetes Federation criteria.

Results

Abdominal obesity was the most common risk factor (20.1%) in females, while hypertension in males (25.1%). MetSy was found in 9.5% patients, predominantly in females. Patients with MetSy exhibited higher insulin requirement per body surface area and higher glycated hemoglobin than patients without MetSy. Overweight/obese patients had a much higher prevalence of MetSy than normal weight patients. The logistic regression analysis showed that just waist-to-height ratio and insulin dose per body surface area contributed to discriminate subjects with the MetSy from those without.

Conclusion

Adolescence is a critical period in determining risk of future vascular complications in T1DM. Pediatric diabetologists need to be aware of the considerable occurrence of abdominal adiposity and MetSy in T1DM patients, particularly in females, and should make any effort to achieve normal weight and better health outcomes.

Introduction

Concomitant with the epidemic of overweight in the general population, a raised weight gain has been also described in type 1 diabetes mellitus (T1DM) children and adolescents [1]. Obesity, and in particular abdominal obesity, can be associated with insulin resistance and clustering of cardiovascular risk factors, known as the metabolic syndrome (MetSy) [2]. Accordingly, a recent definition of MetSy provided in the consensus statement issued by the International Diabetes Federation (IDF) [3], makes central obesity essential for the diagnosis, and proposes a more stringent threshold to define high waist circumference with respect to other definitions [4]. Intensive insulin treatment (IIT), directed to achieve blood glucose levels as close to normal as possible through frequent self-monitoring of blood glucose and continuous subcutaneous insulin infusion (CSII) or multiple insulin injections, is strongly recommended to prevent microvascular and macrovascular diabetic complications, but has been also associated with increased weight gain and excess of visceral adiposity [5], [6].

The present study was aimed at analyzing the prevalence of abdominal adiposity and individual risk factors for cardiovascular disease (CVD) in a large sample of Italian adolescents with T1DM. The prevalence of MetSy and its association with diabetes related variables were also analyzed.

Section snippets

Subjects

Four hundred and seventy seven adolescents (253 males) with T1DM were recruited from 18 care referral centres for diabetes in childhood affiliated to the Study Group on Diabetes of the Italian Society of Pediatric Endocrinology and Diabetology.

Inclusion criteria were: Caucasians of Italian origin, age between 16 and 19 years, type 1 diabetes, and duration of diabetes >12 months. Exclusion criteria were: other types of diabetes, or specific treatments for dyslipidemia or hypertension.

The following

Results

All patients were receiving IIT: 75% multiple insulin injection therapy and 25% continuous subcutaneous insulin infusion. BMI, W/Hr, ID per body weight or per body surface area, and HbA1c did not differ between these groups (data not shown), therefore the sample was considered as a whole.

Clinical features of the patients are shown in Table 1. Females had higher W/Hr and HDL-cholesterol and lower SBP than males.

Prevalence of individual cardiovascular risk factors is summarized in Table 2.

Discussion

The main results of this study in T1DM adolescents are that: (1) abdominal obesity in females and hypertension in males were the most frequent CVD risk factors; (2) prevalence of MetSy was 9.5%, it was more common in females and in overweight/obese patients; (3) W/Hr and high ID per body surface area are independent risk factors for MetSy.

Adolescence is a critical period in determining risk of future vascular complications in T1DM, due to poor adherence to treatment, deteriorating glycemic

Conflict of interest

The authors declare that they have no conflict of interest.

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    The members of the Study-Group on Diabetes of Italian Society of Pediatric Endocrinology and Diabetology are considered co-authors and are listed in Appendix A.

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