ESPE Abstracts

Pediatric overweight and obesity are also an issue in children and adolescents with type 1 diabetes (T1D). Body Mass Index (BMI) is an accurate and widely used clinical method for assessing childhood obesity.

Objective: To analyze the BMI-standard deviation scores (SDS) in Bulgarian children and adolescents with T1D and its relationship with age, gender, type of insulin treatment, and HbAlc.

Materials and Methods: Two consecutive national multi-center cross-sectional studies of HbA1c in Bulgarian pediatric patients with T1D were done during 2012 and 2014 in 11 pediatric endocrine practices. 829 patients participated (422 boys, 407 girls) in the first study (mean age 11.9 ± 4.2 years), and 498 patients (261 boys, 237 girls) - in the second one (mean age 11.6 ± 4.1 years). BMI-SDS were calculated and compared to the WHO BMI charts (z-scores). Patients were divided into the following groups: underweight (UW) with BMI-SDS < −2SD, normal weight (NW): -2SD ≤ BMI-SDS ≤ +1SD, overweight (OW): +1SD < BMI-SDS ≤ +2SD, and obese (OB): BMI-SDS > +2SD.

Results: The mean BMI-SDS between different endocrine centers in the country varied considerably from 0.15±0.98 up to1.07±0.70. We found significantly higher mean BMI-SDS for boys (0.50±1.07) compared to the girls (0.28 ± 0.99), (P<0.001). The average BMI-SDS in boys decreased with age, being highest in boys under 6 years of age (1.01±1.27). In both studies, the percentage of overweight and obese boys, was significantly higher than for girls. The prevalence of UW, NW, OW and OB in the first study was: 0.5%, 70.9%, 22.0%, 6.6% for boys and 1.0%, 76.7%, 17.9%, 4.4% for girls. The prevalence of UW, NW, OW and OB in the second study was: 0.8%, 65.5%, 25.3%, 8.0% for boys and 1.0%, 78%, 16.5%, and 4.6% for girls. We found a weak but significant negative correlation between BMI-SDS and HbA1c only for boys (P<0.009). The girls with T1D and HbA1c <7.5% had significantly lower mean BMI-SDS than girls with HbA1c >7.5% (P=0.006). The boys treated with insulin analogs had a significantly lower mean BMI-SDS of 0.35±0.98 than those treated with human insulins: BMI SDS 0.49±1.16, (P=0.032). There was no such dependence for girls.

Conclusions: In our studies, significantly more girls with T1D had a normal BMI-SDS compared to boys. The established higher percentage of overweight and obesity in boys with T1D since early childhood requires measures to balance caloric intake, in order to prevent this unfavorable issue in pediatric diabetes.