ESPE Abstracts

Children with Type 1 diabetes are experiencing higher levels of overweight and obesity as a consequence of intensive insulin therapy as well as background socioeconomic and environmental factors that are contributing to excess adiposity in the general population. The consequences of obesity in people with type 1 diabetes are of particular concern, as obesity in adults increases the risk of both diabetes-related and obesity-related complications, including cardiovascular disease and various types of cancer. Obesity is understood to result in a state of low-grade inflammation. Recently IL 17 has been implicated in the pathophysiology of insulin resistance. We performed a cross sectional study on children (5-16) with T1DM who had obesity and children who had T1DM but had a normal bodyweight. We also recruited otherwise healthy children and children with simple obesity to act as a control. Eighty-eight children were recruited into the study. We measured pro inflammatory cytokines (IL17, TNF alpha, IL1) in the sera of these children by high sensitivity ELISA. We measured adipokines (leptin and adiponectin) by ELISA. We performed cell culture and measured inflammatory cytokine responses (TNFα, IL 17A, IL17F, IL17, sCD163, IL1beta, IFNgamma) of peripheral blood mononuclear cells to stimuli (LPS, TCR and PMA/ionomycin) in vitro. We measured residual c-peptide in children with T1DM. Children with T1DM and obesity had higher serum TNFα levels and higher serum IL1 levels compared to children with T1DM with a normal BMI z-score. There was no difference in serum IL17 levels between both groups with T1DM whereas children who had simple obesity had significantly higher serum IL17. The PBMC of children with T1DM and obesity produced more IL17F in response to stimulation with TCR beads but had a similar TNFα, IFNγ, IL17A production and sCD163 response. Children with T1DM and obesity had higher leptin levels and lower adiponectin levels. Children with T1DM and obesity had the same HbA1c, and had no more microvascular complications than the T1DM lean controls. Children with comorbid obesity had a higher insulin units/kg/day despite no differences in residual c-peptide. Our findings highlight some biochemical proinflammatory changes in the blood of children with Type 1 diabetes and obesity. This is reflected clinically in the higher insulin requirements of this cohor. These findings support the call to manage these children individually to optimise long term health. Balancing glycaemic control and weight management is an under met need in the care of paediatric diabetes.