Beta cell function and BMI in ethnically diverse children with newly diagnosed autoimmune type 1 diabetes
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Published on: May 6, 2013
Maria J Redondo1, Luisa M Rodriguez, Mirna Escalante
1Department of Pediatrics, Section of Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX 77030, USA. redondo@bcm.edu
Insights
Children with overweight or obesity have better beta-cell function at autoimmune type 1 diabetes (T1D) diagnosis. This suggests higher BMI is linked to preserved insulin production in newly diagnosed T1D in youth.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Autoimmune Diseases
Background:
- Type 1 diabetes (T1D) is an autoimmune condition characterized by the destruction of pancreatic beta cells, leading to insulin deficiency.
- Body Mass Index (BMI) is a common metric for assessing weight status, with increasing prevalence of overweight and obesity in children globally.
- The interplay between BMI, metabolic status, and beta-cell function in pediatric autoimmune T1D at diagnosis remains an area of active investigation.
Purpose of the Study:
- To investigate the association between Body Mass Index (BMI) and residual beta-cell function, measured by serum C-peptide levels, in a diverse cohort of children newly diagnosed with autoimmune type 1 diabetes (T1D).
- To identify factors influencing beta-cell function at the time of T1D diagnosis in pediatric populations.
Main Methods:
- A cross-sectional analysis was conducted on 524 ethnically diverse children with newly diagnosed autoimmune T1D.
- Data collected included BMI, serum C-peptide levels, glycemia, HbA1c, diabetes ketoacidosis (DKA) status, age, sex, Tanner stage, race/ethnicity, and number of anti-islet antibodies.
- Statistical models were used to assess the relationship between BMI categories (underweight, normal, overweight, obese) and preserved C-peptide levels (≥0.6 ng/mL), adjusting for relevant covariates.
Main Results:
- Over one-fifth (22.2%) of the children studied were classified as overweight or obese.
- Children who were overweight or obese exhibited significantly higher median serum C-peptide levels compared to lean children (p < 0.0001).
- Higher BMI was independently associated with increased odds of preserved C-peptide (2.4-fold for overweight, 4.1-fold for obese vs. lean), along with older age, female sex, and absence of DKA at presentation. HbA1c was inversely associated with C-peptide.
Conclusions:
- Overweight and obese children demonstrate greater beta-cell function at the onset of autoimmune type 1 diabetes compared to their lean counterparts.
- These findings highlight a complex relationship between adiposity and metabolic function in pediatric T1D.
- Further prospective research is warranted to elucidate the long-term implications of BMI on beta-cell function and disease progression in T1D.
Objective:
To examine the relationship between BMI and beta-cell function at diagnosis of autoimmune type 1 diabetes (T1D) in a large group of ethnically diverse children.
Methods:
Cross-sectional analysis of 524 children (60.8% White, 19.5% Hispanic, 14.5% African-American, 5.2% other non-Hispanic; mean age = 9.8 yr [SD = 2.5]) with newly diagnosed autoimmune T1D.
Results:
As much as 22.2% of children were overweight or obese. Median random serum C-peptide was 0.40 ng/mL (25th-75th percentiles = 0.3-0.8), with median glycemia of 366 mg/dL (25th-75th percentiles = 271-505). Median C-peptide was 0.3, 0.5, 0.7, and 0.85 ng/mL, respectively, in underweight, normal weight, overweight, and obese children (p < 0.0001, Kruskal-Wallis). In the final model (p < 0.0001), the odds of having preserved C-peptide (≥0.6 ng/mL) were increased by 2.4-fold (95% CI = 1.2-4.9, p < 0.015) and 4.1-fold (1.9-8.5, p < 0.0001), respectively, in overweight and obese compared to lean children; 1.3-fold per each year of age; 2.5-fold in girls compared to boys; 4-fold in children who presented without, compared to with, diabetes ketoacidosis (DKA); and decreased by 21% for each point increase in HbA1c. Tanner stage, race/ethnicity, glycemia, and number of anti-islet antibodies expressed were not independently associated with preserved C-peptide. The association between BMI and C-peptide levels was significant in children with and without preserved C-peptide. Excluding patients who presented with DKA and/or using BMI obtained 5 wk after diagnosis did not alter the results.
Conclusion:
Obese and overweight children compared to lean children have greater beta-cell function at the onset of autoimmune T1D. Prospective studies on the relationships among BMI, beta-cell function, and progression to clinical T1D are warranted.
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