OBJECTIVE: To assess the prevalence of underweight (UW), overweight (OW), and obesity in children and adolescents with type 1 diabetes (T1D). METHODS: An international cross-sectional study including 23 026 T1D children (2-18 years, duration of diabetes ≥1 year) participating in the SWEET prospective, multicenter diabetes registry. Body mass index SD score (BMI-SDS) was calculated using the World Health Organization BMI charts. Children were categorized as UW (BMI-SDS < -2SD), OW (+1SD < BMI-SDS ≤ +2SD), and obese (OB) (BMI-SDS > +2SD). Hierarchic regression models were applied with adjustment for sex, age, and duration of diabetes. RESULTS: The prevalence of UW, OW, and obesity was: 1.4%, 22.3%, and 7.3% in males and 0.6%, 27.2%, and 6.8% in females. Adjusted BMI-SDS was significantly higher in females than in males (mean ± SEM: 0.54 ± 0.05 vs 0.40 ± 0.05, P < 0.0001). In males, BMI-SDS significantly decreased by age (P < 0.0001) in the first three age categories 0.61 ± 0.06 (2 to <10 years), 0.47 ± 0.06 (10 to <13 years), 0.34 ± 0.05 (13 to <16 years). In females, BMI-SDS showed a U-shaped distribution by age (P < 0.0001): 0.54 ± 0.04 (2 to <10 years), 0.39 ± 0.04 (10 to <13 years), 0.55 ± 0.04 (13 to <16 years). BMI-SDS increased by diabetes duration (<2 years: 0.38 ± 0.05, 2 to <5 years: 0.44 ± 0.05, and ≥5 years: 0.50 ± 0.05, P < 0.0001). Treatment modality did not affect BMI-SDS. Adjusted HbA1c was significantly higher in females than in males (8.20% ± 0.10% vs 8.06% ± 0.10%, P < 0.0001). In both genders, the association between HbA1c and BMI-SDS was U-shaped with the highest HbA1c in the UW and obesity groups. CONCLUSIONS: The high rate of OW and obesity (31.8%) emphasize the need for developing further strategies to prevent and treat excess fat accumulation in T1D.

1st Department of Pediatrics Semmelweis University Budapest Hungary

Alberta Children's Hospital Research Institute University of Calgary Calgary Alberta Canada

APDP Diabetes Portugal Department of Pediatric and adolescents Lisbon Portugal

Barbara Davis Center University of Colorado Aurora Colorado

Clinic for Endocrinology Diabetes and Genetics Medical University Sofia University Pediatric Hospital Sofia Bulgaria

Deccp Pediatric Clinic Centre Hospitalier de Luxembourg Luxembourg Grand Duche de Luxembourg

Department of Development and Regeneration University of Leuven Leuven Belgium

Department of Pediatric and adolescents Copenhagen University hospital Herlev Denmark

Department of Pediatrics Aarhus University Hospital Aarhus Denmark

Department of Pediatrics Motol University Hospital Prague Czech Republic

Department of Pediatrics University Hospitals Leuven Leuven Belgium

Department of Women's and Children Health Salesi Hospital Ancona Italy

Diabetes Center 1st Department of Pediatrics Medical School National and Kapodistrian University of Athens Agia Sophia Children's Hospital Athens Greece

Diabetes Center P and A Kyriakou Children's Hospital Athens Greece

General Private Practitioner at T1diams Mauritius Island

German Center for Diabetes Research Munich Neuherberg Germany

Hospital Dona Estefânia Unit of Pediatric Endocrinology and Diabetes Lisbon Portugal

Institute of Epidemiology and Medical Biometry ZIBMT University of Ulm Ulm Germany

KLE Diabetes Centre KLE University JNMC and KLE'S Dr Prabhakar Kore Hospital and MRC Belagavi India

Pediatric Diabetes and Metabolic Disorders Unit University of Verona University City Hospital Verona Italy

Queen Silvia Children's Hospital Sahlgrenska University Hospital Gothenburg Sweden

Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel

The Jesse Z and Lea Shafer Institute of Endocrinology and Diabetes Schneider Children's Medical Center of Israel Petach Tikva Israel

The Sahlgrenska Academy University of Gothenburg Gothenburg Sweden and NU Hospital Group Uddevalla Sweden

University Children's Hospital Department of Endocrinology Diabetes and Metabolic Diseases Ljubljana Slovenia

References provided by Crossref.org

Basal and Bolus Insulin Distribution According to Treatment Modality: Data from SWEET Diabetes Registry