儿童青少年1型糖尿病体质指数变化及相关性分析

doi:10.12372/jcp.2023.22e0686

摘要/Abstract

摘要：

目的比较1型糖尿病（T1DM）患儿确诊时与末次随访时体重指数标准差积分（BMISDS），并揭示影响其变化的相关因素。方法回顾性分析2017年6月至2021年1月内分泌科收治的首次诊断T1DM患儿的临床资料。并分析各因素与ΔBMISDS的相关性。结果纳入T1DM患儿53例，男26例、女27例，中位随访病程为3.0（1.5~4.0）年。确诊时中位年龄8.0（5.5~11.0）岁，BMISDS为-1.1（-1.8~0.6），超重肥胖12例（22.6%）。至末次随访，42例完成随访，中位年龄12.0（8.8~13.3）岁，BMISDS为0（-0.6~0.7）；超重肥胖5例（11.9%）。末次随访时的BMISDS高于确诊时，差异有统计学意义（P<0.01）。确诊时非超重肥胖的患儿41例，30例完成随访，男14例，ΔBMISDS为0.3（-0.3~1.8），女16例，ΔBMISDS为1.9（1.1~2.2），女性的ΔBMISDS高于男性，差异有统计学意义（P<0.05）。0~5岁、5~10岁以及≥10岁组，女孩的ΔBMISDS均高于男孩，差异有统计学意义（P<0.05）。ΔBMISDS与确诊时BMISDS、空腹C肽（FCP）、游离三碘甲状腺原氨酸（FT₃）、游离甲状腺素（FT₄）、促甲状腺激素（TSH）呈显著负相关（P<0.05），与确诊时糖化血红蛋白（HbA1c）呈显著正相关（P<0.05）。在多元线性回归中ΔBMISDS与确诊时BMISDS、TSH依然呈显著负相关（P<0.05）。结论 T1DM患儿BMISDS在病程中呈现增加的趋势，与性别、确诊时BMISDS、TSH相关，应制定合适的干预措施，降低超重肥胖及其并发症的发生。

关键词: 1型糖尿病, 体质指数, 超重肥胖, 儿童青少年

Abstract:

Objective To compare the body mass index standard deviation scores (BMISDS) at diagnosis and last follow-up in children with type 1 diabetes mellitus (T1DM), and to reveal the related factors affecting the change of BMISDS. Methods The clinical data of children with T1DM initially diagnosed in the endocrinology department from June 2017 to January 2021 were retrospectively analyzed. The correlation between each factor and ΔBMISDS was analyzed. Results Fifty-three children with T1DM (26 boys and 27 girls) were included, and the median course of follow-up was 3.0 (1.5-4.0) years. The median age at diagnosis was 8.0 (5.5-11.0) years, the BMISDS were -1.1 (-1.8-0.6) and 12 patients (22.6%) were overweight and obese. Forty-two patients completed the last follow-up. The median age was 12.0 (8.8-13.3) years, the BMISDS were 0 (-0.6-0.7) and 5 patients (11.9%) were overweight and obese. The BMISDS at the last follow-up were higher than that at diagnosis, the difference was statistically significant (P<0.01). Of the 41 children who were not overweight and obese at the time of diagnosis, 30 completed the last follow-up. The ΔBMISDS of 14 boys and 16 girls were 0.3 (-0.3-1.8) and 1.9 (1.1-2.2), respectively. The ΔBMISDS of girls was higher than that of boys, and the difference was statistically significant (P<0.05). The ΔBMISDS of girls were higher than that of boys in 0~5 years old, 5~10 years old and ≥10 years old groups, and the difference was statistically significant (P<0.05). ΔBMISDS was significantly negatively correlated with BMISDS, fasting C-peptide (FCP), free triiodothyronine (FT₃), free thyroxine (FT₄) and thyrotropin (TSH) at diagnosis (P<0.05), and significantly positively correlated with glycosylated hemoglobin (HbA1c) at diagnosis (P<0.05). In multiple linear regression, ΔBMISDS was still significantly negatively correlated with BMISDS and TSH at diagnosis (P<0.05). Conclusions BMISDS in children with T1DM showed an increasing trend in the course of disease, which was related to gender, BMISDS and TSH at the time of diagnosis. Appropriate intervention measures should be developed to reduce the occurrence of overweight, obesity and its complications.

Key words: type 1 diabetes mellitus, body mass index, overweight and obesity, child and adolescent

赵玲, 刘晓静. 儿童青少年1型糖尿病体质指数变化及相关性分析[J]. 临床儿科杂志, 2023, 41(7): 519-525.

ZHAO Ling, LIU Xiaojing. Changes of body mass index and its related factors in children and adolescents with type 1 diabetes mellitus[J]. Journal of Clinical Pediatrics, 2023, 41(7): 519-525.

图/表 5

表1

表2

表3

表4

表5

参考文献 39

[1]	Harreiter J, Roden M. Diabetes mellitus-definition, classification, diagnosis, screening and prevention (Update 2019)[J]. Wien Klin Wochenschr, 2019, 131(Suppl 1): 6-15. doi: 10.1007/s00508-019-1450-4 pmid: 30980151
[2]	罗飞宏. 儿童1型糖尿病的诊治与展望[J]. 临床儿科杂志, 2022, 40(5): 321-327.
[3]	Nevo-Shenker M, Phillip M, Nimri R, et al. Type 1 diabetes mellitus management in young children: implementation of current technologies[J]. Pediatr Res, 2020, 87(4): 624-629. doi: 10.1038/s41390-019-0665-4 pmid: 31715623
[4]	Patterson CC, Karuranga S, Salpea P, et al. Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: results from the international diabetes federation diabetes atlas, 9th edition[J]. Diabetes Res Clin Pract, 2019, 157: 107842. doi: 10.1016/j.diabres.2019.107842
[5]	Minges KE, Whittemore R, Weinzimer SA, et al. Correlates of overweight and obesity in 5529 adolescents with type 1 diabetes: The T1D exchange clinic registry[J]. Diabetes Res Clin Pract, 2017, 126: 68-78. doi: 10.1016/j.diabres.2017.01.012
[6]	中华医学会儿科学分会内分泌遗传代谢学组, 中华儿科杂志编辑委员会. 中国儿童1型糖尿病标准化诊断与治疗专家共识(2020版)[J]. 中华儿科杂志, 2020, 58(6): 447-454.
[7]	中华医学会儿科学分会内分泌遗传代谢学组, 中华儿科杂志编辑委员会. 儿童糖尿病酮症酸中毒诊疗指南(2009年版)[J]. 中华儿科杂志, 2009, 47(6): 421-425.
[8]	李辉, 季成叶, 宗心南, 等. 中国0-18岁儿童、青少年体块指数的生长曲线[J]. 中华儿科杂志, 2009, 47(7): 493-498.
[9]	Maffeis C, Birkebaek NH, Konstantinova M, et al. Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: data from the international SWEET registry[J]. Pediatr Diabetes, 2018, 19(7): 1211-1220. doi: 10.1111/pedi.12730 pmid: 30033651
[10]	Wilkin TJ. The accelerator hypothesis: weight gain as the missing link between type 1 and type 2 diabetes[J]. Diabetologia, 2001, 44(7): 914-922. pmid: 11508279
[11]	Mochizuki M, Ito Y, Yokomichi H, et al. Increasing secular trends in height and obesity in children with type 1 diabetes: JSGIT cohort[J]. PLoS One, 2020, 15(11): e0242259.
[12]	Bitkin EC, Kara C, Yılmaz GC, et al. Evaluation of children with type 1 diabetes mellitus in terms of overweight/obesity in tertiary care hospital[J]. J Pediatr Endocrinol Metab, 2021, 34(8): 995-1000. doi: 10.1515/jpem-2021-0268 pmid: 34162026
[13]	De Keukelaere M, Fieuws S, Reynaert N, et al. Evolution of body mass index in children with type 1 diabetes mellitus[J]. Eur J Pediatr, 2018, 177(11): 1661-1666. doi: 10.1007/s00431-018-3224-9 pmid: 30091111
[14]	Mao L, Lu W, Ji F, et al. Development and linear growth in diabetic children receiving insulin pigment[J]. J Pediatr Endocrinol Metab, 2011, 24(7-8): 433-436. pmid: 21932577
[15]	Fröhlich-Reiterer EE, Rosenbauer J, Bechtold-Dalla Pozza S, et al. Predictors of increasing BMI during the course of diabetes in children and adolescents with type 1 diabetes: data from the German/Austrian DPV multicentre survey[J]. Arch Dis Child, 2014, 99(8): 738-743. doi: 10.1136/archdischild-2013-304237 pmid: 24812301
[16]	Kadłubiska A, Małachowska B, Noiszewska K, et al. Five-year observation of the relationship between body mass index and glycated hemoglobin in children with type 1 diabetes mellitus[J]. Scand J Clin Lab Invest, 2018, 78(5): 398-406. doi: 10.1080/00365513.2018.1487073
[17]	Ferrara-Cook C, Geyer SM, Evans-Molina C, et al. Excess BMI accelerates islet autoimmunity in older children and adolescents[J]. Diabetes Care, 2020, 43(3): 580-587. doi: 10.2337/dc19-1167 pmid: 31937610
[18]	Özkaya V, Eren E, Özgen Özkaya Ş, et al. Prevalence of obesity in prepubertal and pubertal with Turkish population type 1 diabetes[J]. Diabetol Int, 2021, 12(4): 412-419. doi: 10.1007/s13340-021-00498-2
[19]	Murphy MJ, Metcalf BS, Voss LD, et al. Girls at five are intrinsically more insulin resistant than boys: theprogramming hypotheses revisited--the EarlyBird study (EarlyBird 6)[J]. Pediatrics, 2004, 113(1 Pt 1):82-86. doi: 10.1542/peds.113.1.82
[20]	Pinhas-Hamiel O, Levek-Motola N, Kaidar K, et al. Prevalence of overweight, obesity and metabolic syndrome components in children, adolescents and young adults with type 1 diabetes mellitus[J]. Diabetes Metab Res Rev, 2015, 31(1): 76-84. doi: 10.1002/dmrr.v31.1
[21]	Prinz N, Schwandt A, Becker M, et al. Trajectories of body mass index from childhood to young adulthood among patients with type 1 diabetes-a longitudinal group-based modeling approach based on the DPV registry[J]. J Pediatr, 2018, 201: 78-85. doi: 10.1016/j.jpeds.2018.05.014
[22]	Flokas ME, Zeymo A, Mete M, et al. Overweight and obese children with optimal control in the T1D exchange registry: how are they different from lean children with optimal control?[J]. J Diabetes Complications. 2020, 34(4): 107513. doi: 10.1016/j.jdiacomp.2019.107513
[23]	Apperley LJ, Ng SM. Increased insulin requirement may contribute to risk of obesity in children and young people with type 1 diabetes mellitus[J]. Diabetes Metab Syndr, 2019, 13(1): 492-495. doi: S1871-4021(18)30444-2 pmid: 30641751
[24]	Li X, Cheng J, Huang G, et al. Tapering decay of β-cell function in Chinese patients with autoimmune type 1 diabetes: a four-year prospective study[J]. J Diabetes, 2019, 11(10): 802-808. doi: 10.1111/1753-0407.12907 pmid: 30767397
[25]	Barker A, Lauria A, Schloot N, et al. Age-dependent decline of β-cell function in type 1 diabetes after diagnosis: a multi-centre longitudinal study[J]. Diabetes Obes Metab, 2014, 16(3): 262-267. doi: 10.1111/dom.12216 pmid: 24118704
[26]	Dabelea D, Mayer-Davis EJ, Andrews JS, et al. Clinical evolution of beta cell function in youth with diabetes: the SEARCH for diabetes in youth study[J]. Diabetologia, 2012, 55(12): 3359-3368. doi: 10.1007/s00125-012-2719-6 pmid: 22990715
[27]	Weight gain associated with intensive therapy in the diabetes control and complications trial. The DCCT Research Group[J]. Diabetes Care, 1988, 11(7): 567-573. doi: 10.2337/diacare.11.7.567
[28]	Cheng J, Yin M, Tang X, et al. Residual β-cell function after 10 years of autoimmune type 1 diabetes: prevalence, possible determinants, and implications for metabolism[J]. Ann Transl Med, 2021, 9(8): 650. doi: 10.21037/atm-20-7471 pmid: 33987348
[29]	DiMeglio LA, Acerini CL, Codner E, et al. ISPAD clinical practice consensus guidelines 2018: glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes[J]. Pediatr Diabetes, 2018, 19 (Suppl 27): 105-114. doi: 10.1111/pedi.2018.19.issue-S27
[30]	Birkebaek NH, Kahlert J, Bjarnason R, et al. Body mass index standard deviation score and obesity in children with type 1 diabetes in the Nordic countries. HbA1c and other predictors of increasing BMISDS[J]. Pediatr Diabetes, 2018, 19(7): 1198-1205. doi: 10.1111/pedi.12693 pmid: 29781227
[31]	Nansel TR, Lipsky LM, Iannotti RJ. Cross-sectional and longitudinal relationships of body mass index with glycemic control in children and adolescents with type 1 diabetes mellitus[J]. Diabetes Res Clin Pract, 2013, 100(1): 126-132. doi: 10.1016/j.diabres.2012.12.025
[32]	Benvenga S, Pintaudi B, Vita R, et al. Serum thyroid hormone autoantibodies in type 1 diabetes mellitus[J]. J Clin Endocrinol Metab, 2015, 100(5): 1870-1878. doi: 10.1210/jc.2014-3950 pmid: 25710564
[33]	范言诗, 张建萍, 谢晓恬. 儿童1型糖尿病与甲状腺功能降低的相关性研究[J]. 现代实用医学, 2020, 32(1): 89-91.
[34]	Soydan L, Eren Ozturk H, Onal ZE, et al. Associations of throid volume and function with childhood obestiy[J]. Acta Endocrinol (Buchar), 2019, 5(1): 123-128.
[35]	Marlow AL, Rowe CW, Anderson D, et al. Young children, adolescent girls and women with type 1 diabetes are more overweight and obese than reference populations, and this is associated with increased cardiovascular risk factors[J]. Diabet Med, 2019, 36(11): 1487-1493. doi: 10.1111/dme.v36.11
[36]	Phelan H, Foster NC, Schwandt A, et al. Longitudinal trajectories of BMI z-score: an international comparison of 11,513 Australian, American and German/Austrian/Luxembourgian youth with type 1 diabetes[J]. Pediatr Obes, 2020, 15(2): e12582.
[37]	Deeb A, Abu-Awad S, Tomy M, et al. Relationship between basal insulin requirement and body mass index in children and adults with type 1 diabetes on insulin pump therapy[J]. J Diabetes Sci Technol, 2015, 9(3): 711-712. doi: 10.1177/1932296815572681 pmid: 25691654
[38]	Hong KMC, Glick BA, Kamboj MK, et al. Glycemic control, depression, diabetes distress among adolescents with type 1 diabetes: effects of sex, race, insurance, and obesity[J]. Acta Diabetol, 2021, 58(12): 1627-1635. doi: 10.1007/s00592-021-01768-w pmid: 34213654
[39]	Corbin KD, Driscoll KA, Pratley RE, et al. Obesity in type 1 diabetes: pathophysiology, clinical impact, and mechanisms[J]. Endocr Rev, 2018, 39(5): 629-663. doi: 10.1210/er.2017-00191 pmid: 30060120

Metrics

Viewed

Full text

611

HTML			PDF

Just accepted	Online first	Issue	Just accepted	Online first	Issue
0	0	6	0	0	605

From	Others	local

Times	301	310
Rate	49%	51%

Abstract

308

Just accepted	Online first	Issue

0	0	308

From	Others	local

Times	39	269
Rate	13%	87%

Cited

Web of Science	Crossref	ScienceDirect	Search for Citations in Google Scholar >>


This page requires you have already subscribed to WoS.

Shared

项目	数值
确诊时
男[n(%)]	26(49.1)
初诊年龄[M(P₂₅~P₇₅)]/岁	8.0(5.5~11.0)
BMI[M(P₂₅~P₇₅)]/kg·m^-2	14.3(13.1~17.6)
BMISDS[M(P₂₅~P₇₅)]	-1.1(-1.8~0.6)
胰岛素剂量(x±s)/IU·kg^-1·d^-1	0.9±0.2
FCP[M(P₂₅~P₇₅)]/ng·mL^-1	0.3(0.1~0.4)
HbA1c(x±s)/%	12.8±2.3
FT₃(x±s)/pmol·L^-1	3.8±1.0
FT₄(x±s)/pmol·L^-1	16.2±3.9
TSH[M(P₂₅~P₇₅)]/μIU·mL^-1	2.2(1.6~3.4)
GADA阳性[n(%)]	5(9.4)
IA-2A阳性[n(%)]	3(5.7)
超重及肥胖[n(%)]	12(22.6)
末次随访¹⁾
年龄[M(P₂₅~P₇₅)]/岁	12.0(8.8~13.3)
中位随访病程[M(P₂₅~P₇₅)]/a	3.0(1.5~4.0)
BMI[M(P₂₅~P₇₅)]/kg·m^-2	17.8(15.8~20.1)
BMISDS[M(P₂₅~P₇₅)]	0(-0.6~0.7)
ΔBMISDS[M(P₂₅~P₇₅)]	0.8(-0.4~2.0)
胰岛素剂量[M(P₂₅~P₇₅)]/IU·kg^-1·d^-1	0.8(0.5~1.0)
FCP[M(P₂₅~P₇₅)]/ng·mL^-1	0.1(0.0~0.4)
HbA1c(x±s)/%	7.1±1.6
超重及肥胖[n(%)]	5(11.9)
胰岛素给药[n(%)]
CSII	6(14.3)
MDI	36(85.7)
血糖监测[n(%)]
CGM	20(47.6)
指尖血糖	22(52.4)

项目	分组	例数	ΔBMISDS	Z值	P
性别	男	22	0.3(-0.5~1.7)	1.74	0.082
	女	20	1.3(-0.1~2.2)	1.74	0.082
是否DKA	非DKA	21	0.3(-0.6~1.9)	1.12	0.263
	DKA	21	1.4(-0.1~2.0)	1.12	0.263
胰岛素给药方式	CSII	6	0.8(-0.7~1.9)	0.36	0.719
	MDI	36	0.8(-0.4~2.1)	0.36	0.719
血糖监测方式	CGM	20	1.2(-0.4~1.9)	0.08	0.940
	指尖血糖	22	0.3(-0.4~2.0)	0.08	0.940

年龄段	性别（n）	ΔBMISDS	Z值	P
0~5岁	男（4）	0.8(-0.1~1.0)	2.09	0.037
0~5岁	女（5）	1.3(0.9~1.6)	2.09	0.037
5~10岁	男（11）	0.6(-0.5~1.1)	2.29	0.022
5~10岁	女（10）	1.5(0.7~1.9)	2.29	0.022
≥10岁	男（7）	0.3(0.1~1.3)	2.03	0.048
≥10岁	女（5）	1.2(1.0~1.7)	2.03	0.048

项目	年龄	病程	确诊时							末次随访时
项目	年龄	病程	BMISDS	胰岛素剂量	FCP	HbA1c	FT₃	FT₄	TSH	胰岛素剂量	FCP	HbA1c
r值	-0.03	-0.23	-0.78	0.12	-0.32	0.34	-0.40	-0.38	-0.47	0.02	0.14	-0.14
P	0.874	0.148	<0.001	0.463	0.041	0.030	0.024	0.015	0.004	0.925	0.561	0.476

变量	偏回归系数	标准误	t值	P
确诊时BMISDS	-0.41	0.12	-3.49	0.002
确诊时TSH	-0.24	0.11	-2.30	0.029
常量	3.09	1.50	2.04	0.051