Rapid weight gain in children soon after diagnosis of type 1 diabetes: is there room for concern?
OBJECTIVE
To examine weight status in children at diagnosis (Dx) of type 1 diabetes and observe weight change post-Dx.


METHODS
Data on 136 subjects (76 M/60 F) with type 1 diabetes diagnosed in 1998-2001 at Children's Hospital San Diego was obtained from Institutional Review Board (IRB)-approved database. All patients received two daily insulin injections (NPH/Regular) and were examined at least twice, up to 7 months post-Dx.


RESULTS
Average age at Dx (SD) was 9.02 yr (4.46)yr; 63.9% were Caucasian, 25% Mexican American (MA), 2.9% African American, 0.7% Asian, and 7.3% mixed. Diabetic ketoacidosis rate was more common in MA (44.1%) vs. Caucasians (20.9%) at Dx (p < 0.02). Average body mass index Z-score (BMI-Z) at Dx was -0.28 (39th percentile); 13.5% had BMI > or = 85th percentile, and 7.2% were obese. By 2 wk, and 15-41 d post-Dx, mean weight gain was 9% (5.9) and 12.8% (8), respectively. Mean A1C at Dx, 42-70 and 71-139 d later, was 11.4, 7.6, and 6.9%, respectively. Coinciding with improved glycemic control, by 10 wk, mean BMI-Z reached a plateau of 0.86 (80th percentile). On average, MA were heavier than Caucasians at Dx (p = 0.006), and remained heavier. By 71-139 d, 31.7% had BMI > or = 85th percentile and 15.9% were obese; 47.8% of 2- to 5-yr olds had BMI > or = 85th percentile vs. 22.6% nationally (p < 0.005) CONCLUSIONS: Despite the initial weight loss at Dx of type 1 diabetes, by 10-20 wk post-Dx, almost one third were overweight and obese, more so in MA. In light of the obesity epidemic, closer attention to overall caloric intake in children with new onset diabetes is prudent.
Newfield
Ron S
RS
Division of Pediatric Endocrinology, Department of Pediatrics, Rady Children's Hospital - San Diego, San Diego, CA, USA. rnewfield@rchsd.org
Cohen
Daniela
D
Capparelli
Edmund V
EV
Shragg
Paul
P
D000293:Adolescent; D000367:Age Factors; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D016883:Diabetic Ketoacidosis / Q000175:diagnosis / Q000188:drug therapy; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007223:Infant; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D009765:Obesity / Q000453:epidemiology / Q000378:metabolism; D050177:Overweight / Q000453:epidemiology* / Q000378:metabolism; D013851:Thinness / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D015430:Weight Gain / Q000502:physiology
D007004:Hypoglycemic Agents; D007328:Insulin