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

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Attention Deficit Disorder with Hyperactivity / epidemiology
  • Body Height
  • Body Mass Index*
  • Child
  • Diabetes Mellitus, Type 1 / epidemiology*
  • Dyslipidemias / epidemiology
  • Europe / epidemiology
  • Feeding and Eating Disorders / epidemiology
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hypertension / epidemiology
  • Hypoglycemic Agents / therapeutic use
  • Insulin Detemir / therapeutic use
  • Male
  • Puberty
  • Registries
  • Sex Factors
  • Transients and Migrants / statistics & numerical data
  • Young Adult

Substances

  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • hemoglobin A1c protein, human
  • Insulin Detemir