ESPE Abstracts

Introduction: Type 1 diabetes mellitus (T1DM) is associated with significantly higher cardiovascular disease mortality compared to the general population, even when glycated hemoglobin (HbA1c) is less than 7.0%. Inadequate body composition may increase the risk.

Aim and Methods: To evaluate body composition of a group of pediatric patients with T1DM, from Portuguese Pediatric Endocrinology/Diabetic Clinic, using the bioimpedance system (InBodyÒ™). Demographic data, treatment regimens and glycemic control metrics were evaluated at the time of physical and body composition examination. Preschool (< 6 years) and recent diagnosed children (< 6 months) were excluded. Descriptive and analytical analysis, considering a type I error probability (α) of 0.05.

Results: A total of 78 patients, 53% female gender, were included. DM1 was diagnosed at a median of 4.9 (IQR 6.0) years and 86% were on treatment with Continuous Subcutaneous Insulin Infusion (CSII, 25% with automated closed loop model). Median HbA1c was 7.0% (IQR 1.1). Most of the sample had an adequate body mass index (BMI) SDS (60%) and 46% performed regular physical activity (PA) outside the school setting. The median percentage of body fat (PBF) was 18.9% (IQR 14.5), which was abnormal in 43%, with a visceral adiposity of 3 (IQR 5). Despite an adequate BMI, 19% had excessive PBF. Percent Body fat was statistically related to waist-to-hip ratio (r= 0.61; P=0.001), visceral fat (r= 0.88; P<0.001), BMI SDS (r= 0.70; P<0.001), female gender (P<0.001) and PA performed outside school setting (P=0.007). Planned PA was statistically associated with lesser PBF (P=0.007), visceral fat (P=0.003) and waist-to-hip ratio (P=0.008) and higher muscle‐to‐fat ratio (P=0.008). Patients with CSII engaged more frequently in PA than patients with Multiple Daily Injections (P=0.032). No association was found between total daily insulin dose (U/kg) and visceral adiposity, PBF or planned physical activity. Glycemic control metrics (time in range, above or below range; variability coefficient index; glucose management indicator, HbA1c, mean glucose) did not differ neither in those with/without excessive PBF, nor with planned PA.

Discussion: We identified a large proportion of T1DM with excessive PBF, even in patients with normal BMI. PA outside the school setting was associated with a better body composition, including lower PBF and visceral adiposity. In relation to cardiovascular risk of T1DM, and considering the recognized benefit of physical activity, both in metabolic control and attaining glycemic control metrics, this study reinforces the importance of encouraging regular physical activity in this population.