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J Pediatr. 2018 Oct;201:78-85.e4. doi: 10.1016/j.jpeds.2018.05.014. Epub 2018 Jun 21.

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.

Author information

1
Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany. Electronic address: nicole.prinz@uni-ulm.de.
2
Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, University of Ulm, Ulm, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
3
Department of Pediatrics, Diabetes & Endocrinology Care Clinique Pédiatrique, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg.
4
Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Interdisciplinary Obesity Unit, University Medical Center Ulm, Ulm, Germany.
5
Department of Pediatrics and Adolescent Medicine, Division of Pediatric Endocrinology and Diabetes, Medical University Carl Gustav Carus, Dresden, Germany.
6
Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
7
Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Sozialpädiatrisches Zentrum, Abteilung Interdisziplinär, Pediatric Endocrinology and Diabetology, Berlin, Germany.
8
Department of Pediatrics and Adolescent Medicine, Helios Clinical Center, Erfurt, Germany.
9
Department of Pediatrics and Adolescent Medicine, Marienhospital GmbH, Gelsenkirchen, Germany.
10
Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Hospital for Children and Adolescents, University of Witten/Herdecke, Datteln, Germany.
11
German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.

Abstract

OBJECTIVE:

To identify distinct longitudinal patterns of body mass index (BMI) z score in type 1 diabetes from childhood to young adulthood and secondly to determine sex differences as well as associated clinical covariates.

STUDY DESIGN:

A total of 5665 patients with type 1 diabetes (51% male) with follow-up from 8 to 20 years of age from the multicenter diabetes prospective registry DPV were studied (baseline diabetes duration ≥1 years, BMI z score aggregated per year of life). Latent class growth modeling (SAS: PROC TRAJ) was applied to analyze BMI z score over time.

RESULTS:

Six distinct BMI z score trajectories were identified (group 1: 7% of patients, group 2: 22%, group 3: 20%, group 4: 16%, group 5: 25%, and group 6: 10%). Group 1, 2, 5, and 6 had an almost stable BMI z score, either in the low, near-normal, high stable, or chronic overweight range. Group 3 (60% girls) increased their BMI during puberty, whereas group 4 (65% boys) had a BMI decrease. Similar patterns were observed for girls only, whereas boys followed nearly stable trajectories without fluctuation over time. Between the near-normal and the other groups, significant differences (P < .05) in sex ratio, migration background, mental health, height z score, glycated hemoglobin A1c, diabetes treatment, dyslipidemia, hypertension, and smoking were observed.

CONCLUSIONS:

In youth with type 1 diabetes, a great heterogeneity of BMI z score trajectories exists that highlight the importance of personalized sex-specific intervention programs for subjects at risk for unfavorable BMI development.

KEYWORDS:

BMI z score; developmental curves; diabetes; latent class growth modeling; puberty

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