title: A decade of temporal trends in overweight/obesity in youth with type 1 diabetes after the Diabetes Control and Complications Trial.
abstract: BACKGROUND
  Youth with type 1 diabetes (T1D) are at risk for weight gain due to the epidemic of childhood overweight/obesity and common use of intensive insulin therapy; the latter resulted in weight gain in the Diabetes Control and Complications Trial.
  
  
  OBJECTIVE
  To assess overweight/obesity prevalence and intensive insulin therapy use in youth with T1D over a decade and identify factors associated with weight status and glycemic control.
  
  
  METHODS
  We obtained cross-sectional data from four unique cohorts (1999, 2002, 2006, and 2009). Youth (N = 507, 49% male) were 8-16 yr old with T1D duration ≥6 months, A1c 6.0-12.0% (42-108 mmol/mol), and daily insulin dose ≥0.5 U/kg.
  
  
  RESULTS
  Across cohorts, age, body mass index (BMI) percentile, and A1c ranged from 12.0 ± 2.2 to 12.8 ± 2.3 yr, 70 ± 22 to 72 ± 21, and 8.3 ± 1.0 (67 ± 11) to 8.5 ± 1.1% (69 ± 12 mmol/mol), respectively. Intensive insulin therapy use increased from 52 to 97% (p < 0.001) between 1999 and 2009. However, prevalence of overweight/obesity remained similar, 27% (1999), 36% (2002), 33% (2006), and 31% (2009) (p = 0.54), as did z-BMI. In multivariate analysis, higher A1c was related to higher insulin dose (p < 0.01), less frequent blood glucose monitoring (p < 0.001), and non-white race (p < 0.001); A1c was not related to z-BMI, intensive insulin therapy, or cohort. z-BMI was related to insulin dose (p < 0.005) but not intensive insulin therapy or cohort.
  
  
  CONCLUSIONS
  Despite near-universal implementation of intensive insulin therapy, overweight/obesity prevalence in youth with T1D remained stable over a decade, similar to the general pediatric population. However, A1c remained suboptimal, underscoring the need to optimize T1D treatment to reduce future complication risk.
authors.affiliation: Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA.
authors.forename: Charumathi
authors.initials: C
authors.lastname: Baskaran
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Volkening
authors.forename: Monica
authors.initials: M
authors.lastname: Diaz
authors.forename: Lori M
authors.initials: LM
authors.lastname: Laffel
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D015999:Multivariate Analysis; D009765:Obesity / Q000453:epidemiology / Q000209:etiology*; D015995:Prevalence; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: T1D; obesity; overweight; prevalence; youth