Introduction: Daily insulin requirement in type 1 diabetes (T1D) depends on various factors.
Objectives: To study the correlation of waist circumference (WC) and BMI to daily insulin requirements (TDD) and examine the ethnic variation in this correlation. Associations of estimated glucose disposal rate (eGDR) a surrogate marker of insulin resistance were also studied.
Methods: Cross-sectional study of children with T1D attending a diabetes clinic in a multi-ethnic population was conducted. Ethical approval was obtained from Regional Ethics Committee. Data was collected from case notes and patients following written consent. Physical measurements were undertaken in the clinic setting.
Results: patients were recruited. Mean age was 12.7 (±3.1) years, duration of diabetes 5.4 (±3.5) years and HbA1c 80 (±18) mmol/mol. The white (36=Caucasians, 1=white European) and non-white (29=Asian Pakistani, 1=Indian, 2=mixed White Afro-Caribbean) groups had similar demographics and disease profile. Non-whites compared to whites had a higher prevalence of obesity (15% vs 5%), family history of type2 diabetes (T2D) (23% vs 18%) and deprivation (mean IMD score of 42 vs 30). WC and BMI were standardised to Waist-to-height ratios (WHtR) and BMIsds. WHtR and BMIsds were positively correlated to TDD in whites (r=0.61, P<0.05 and r=0.36, P=0.29 respectively) and negatively correlated in non-whites (r=−0.39, P<0.05 and r=−0.36, P<0.05 respectively). Negative correlation was most significant in non-whites with a first degree relative with T2D (r=−0.93, N=7, P<0.001). The eGDR in mg/kg per min was determined using a validated clinical formula utilising WC, hypertension status and HbA1c. On linear regression analysis age adjusted eGDR was negatively associated to having a first degree relative with T2D (P<0.05) in Asians, BMIsds (P<0.001) in Caucasians and positively to disease duration (P<0.05) in both.
Conclusions: Asian Pakistani population with a family history of T2D had a higher insulin requirement and low eGDR at lower WC indicating the presence of insulin resistance. Whereas in the Caucasians a high BMI was associated with increased insulin resistance.
Funding: No funding received.
01 - 03 Oct 2015
European Society for Paediatric Endocrinology