Adolescents with type 1 diabetes can achieve glycemic targets on intensive insulin therapy without excessive weight gain

Abstract

Introduction: The aim of this study was to compare glycemic control and body mass index standard deviation score (BMI-SDS) before and after implementation of intensive insulin therapy using multiple daily injection (MDI) or continuous subcutaneous insulin infusion (CSII) in adolescents with type 1 diabetes (T1D) attending a large multidisciplinary paediatric diabetes clinic in Australia. Methods: Prospective data were collected for cross-sectional comparison of youth aged 10.0–17.9 years (n = 669) from routine follow-up visits to the diabetes clinic in 2004, 2010, and 2016. Outcome measures included HbA1c; BMI-SDS; and insulin regimen. Results: BMI-SDS remained stable between 2004 to 2016 in the 10–13 and 14–17 year age group (0.7 vs. 0.5, p =.12 and 0.7 vs. 0.7, p =.93, respectively). BMI-SDS was not different across HbA1c groups; <53 mmol/mol (7.0%), 53 to <75 mmol/mol (<7.0 to <9.0%) and >75 mmol/mol (>9.0%) in 2004 (p =.873), 2010 (p =.10) or 2016 (p =.630). Mean HbA1c decreased from 2004 to 2016 in the 10–13 year (69 mmol/mol (8.4%) vs. 57 mmol/mol (7.4%), p = <7.0%]). In 2016, this increased to 31% of 10–13 year olds and 21% of 14–17 year olds. Conclusions: BMI-SDS did not increase with the change to intensive insulin therapy despite a doubling in the number of adolescents achieving the recommended glycemic target of <7.0% (53 mmol/mol). HbA1c was not associated with weight gain.