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J Galhardo, P Semedo, L Lopes

Unidade de Endocrinologia Pediátrica; Área de Pediatria Médica; Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE; Lisboa, Portugal

- 42nd Annual Meeting of ISPAD, 26-29/10/ 2016, Valencia, Espanha (Poster)
- Pediatric Diabetes 2016, 17 (Suppl 24): 1-176 (Resumo)

Objectives: We aimed to determine the prevalence of overweight, obesity, metabolic syndrome and its components among a paediatric population of T1D patients.
Methods: We conducted a cross-sectional study in our tertiary paediatric hospital Diabetes Clinic that included 256 patients at least one year into T1D diagnosis. Age, gender, ethnicity, time since diagnosis, additional diseases/drugs, total daily insulin dose (TDI) and delivery method, anthropometrics, blood pressure, HbA1c, lipids, and presence of microvascular complications were obtained from clinical records. Patients with TDI ≥ 1U/Kg were considered insulin resistant.
Results: Patients were 52% female and 91% white; median age was 11 (4–17)yr. Median T1D duration was 5.5 (1.2-14.3)yr; intensive insulin treatment was delivered by multiple daily injections in 79.7%; global mean HbA1c was 7.9 1.6%. Overweight was present in 21% and 9.8% were obese. Among those above 10 yr, 7.4% met metabolic syndrome criteria: 5.9% had high triglycerides, 5.5% had low HDL, but none had hypertension. Patients with TDI ≥ 1U/Kg (18%) were older (14.3 vs 8.1 yr), had longer diabetes duration (6.3 vs 3.5 yr), were more obese (2.8 vs 1.6 BMI-SDS), had lower HDL-c (37.4 vs 52.1 mg/dL), had higher triglycerides (168 vs 131 mg/dL) and had higher ALT (49 vs 22U/L); there was no difference in age of onset or in HbA1c levels.
Conclusions: In our country, the prevalence of overweight in youth is 30%, amongst which 10% is obese. The increasing number of overweight in T1D is associated with insulin resistance and metabolic syndrome. In this “double diabetes” scenario, as the weight comes up, insulin resistance also grows, increasing the TDI and ending in an even heavier child. In these patients, our next goal will be to study how a change in life style and an improvement in peripheral insulin sensitivity will be able to postpone a TDI increment, cutting this vicious circle and reducing the risk for future vascular complications.

Palavras-chave: T1D, metabolic syndrome, obesity, children