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

Abstract

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

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.

Figures/Tables 5

References 39

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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

Changes of body mass index and its related factors in children and adolescents with type 1 diabetes mellitus

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