ESPE Abstracts (2015) 84 FC12.5

Link Between BMI and Insulin Requirement in Children and Young People with Type 1 Diabetes Mellitus

Swathi Upadrasta, Lynne Finnigan, Linda Connellan & Sze May Ng

Department of Paediatric Diabetes, Southport and Ormskirk NHS Trust, Ormskirk, Lancashire, UK

Background: Prevalence of being overweight or obese is increasing in type 1 diabetes mellitus (T1DM). The recent UK National Paediatric Diabetes Audit (NPDA) 2013/14 reported that 36.6% of 0–11 year old children and 43.9% of 12 years and older children are currently overweight or obese. Childhood obesity in T1DM predicts long-term risk of adult diabetes complications. Previous studies have shown significant positive correlation between HbA1c and total insulin requirement by dose per kilogram body weight.

Objective and hypotheses: The objective of our study was to evaluate factors associated with high BMI SDS in Children and Young People (CYP) with T1DM.

Method: We examined the insulin requirement profiles defined by total daily insulin dose per kilogram body weight, BMI SDS, mean HbA1c over 12 months, age at diagnosis and pubertal status of 102 CYP with T1DM between April 2014 to March 2015 in a single paediatric centre.

Results: There were 59 males. 42 were on continuous subcutaneous insulin infusion (CSII), 56 were on multiple daily insulin regimen and four were on twice daily insulin regimen. Mean age at diagnosis was 7.79 years (range 0.16–16.91), mean BMI SDS was 0.89 (range −3.7 to +3.32), mean height SDS was 0.02±2.97 and mean weight SDS was 0.73±3.75. Mean Diastolic blood pressure was 69 mmHg (range 51–89), mean insulin requirement was 1.01 units/kg per day (range 0.38–2.43) and mean HbA1c was 8.0 (range 5.3–13.4). Out of 102 CYP, 24 were pre-pubertal, 28 were pubertal and 50 were post-pubertal. There was significant positive correlation between insulin requirement (units/kg per day) and HbA1c (r=0.59, P<0.01) and significant positive correlation between insulin requirement (units/kg per day) and BMI SDS (r=0.23, P=0.02). BMI SDS was not correlated with HbA1c. Multivariable linear regression analysis of factors affecting BMI SDS (age at diagnosis, HbA1c, gender, pubertal status and insulin in units/kg per day) showed that insulin requirement (units/kg per day) was an independent factor affecting BMI SDS.

Conclusion: There is a link between increased total insulin requirement (units/kg per day) and increased BMI SDS. Higher insulin requirement was also associated with poorer metabolic control.

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