https://t1dexchange.org/pages/u-s-y...esity-epidemic-also-affecting-european-youth/ U.S., Germany, and Austria pediatric type 1 diabetes population at increased risk for insulin resistance, cardiovascular disease; the downside of intensive insulin therapy BOSTON, July 8, 2015 – Adolescents with type 1 diabetes have not escaped the global obesity epidemic and those in the U.S. are significantly more overweight than their German and Austrian counterparts, according to a new study done by researchers from T1D Exchange. The findings are especially concerning as excessive weight puts adolescents with type 1 diabetes at higher risk for insulin resistance, severe hypoglycemia, and cardiovascular disease, which is the leading cause of death for type 1 diabetes patients. Researchers examined height and weight data of nearly 33,000 pediatric type 1 diabetes patients ages two through 18 via two massive databases: the T1D Exchange Clinic Registry, the most comprehensive type 1 diabetes database in the U.S., comprising more than 27,000 patients from 76 pediatric and adult endocrinology centers; and the Diabetes Prospective Follow-up (DPV) registry, a database with more than 40,000 patients from 209 centers in Germany and Austria. Nearly 40 percent of children in both registries were considered obese or overweight. However, children in the T1D Exchange Clinic Registry were more obese than those in the DPV (15 percent compared with 10 percent). The study, published online in The Journal of Pediatrics, is the first international comparison of body mass index (BMI) in pediatric type 1 diabetes patients. Historically, type 1 diabetes patients were often underweight because of ineffective methods of glucose control. However, the Diabetes Control and Complications Trial (DCCT) mandate of intensive insulin therapy for diabetes management, coupled with advanced treatments and technologies for better glycemic control, inadvertently led to increased weight gain. This was due to patients’ glucose being used and stored more effectively by their bodies. “Type 1 diabetes is extremely difficult to manage even under the best circumstances. Thus, the number of young people with this disease who have the added burden of excessive weight is disconcerting to say the least. These patients are at risk for serious complications, especially as they get older,” said corresponding author Stephanie DuBose, MPH, a T1D Exchange investigator and epidemiologist-biostatistician at the Jaeb Center for Health Research. “This research underscores the need for physicians to educate their patients about the importance of maintaining a healthy weight as part of overall diabetes management.” Approximately 35 million people worldwide are living with type 1 diabetes, and over 30,000 new patients—half of whom are children—will be diagnosed this year in the U.S. alone. Type 1 diabetes accounts for about five to 10 percent of all diabetes cases and results from an immune-mediated destruction of insulin-producing pancreatic beta cells, beginning long before—and believed to continue long after—the clinical diagnosis. According to the study, greater BMI was associated with higher HbA1c levels in both registries. Further, it increases the likelihood of insulin resistance and cardiovascular disease risk factors, including hypertension, dyslipidemia, and atherosclerosis. In fact, a recent study done by T1D Exchange that was published in Acta Diabetologica found that obese children with type 1 diabetes have a higher prevalence of hypertension and dyslipidemia than healthy weight children with the disease. Overall the study found that youth with type 1 diabetes have elevated BMI compared with international norms developed by the WHO and respective national norms. Researchers attribute the greater number of overweight/obese patients in the U.S. to lifestyle and nutritional factors that also contribute to the higher obesity rates among non-diabetic children in America. “The obesity problem in the U.S. is well-known, but obesity’s effect on adolescents with type 1 diabetes is overlooked,” said principal investigator David M. Maahs, MD, PhD, a T1D Exchange researcher and associate professor of pediatrics at the Barbara Davis Center for Diabetes at the University of Colorado. “These patients need to avoid excessive calories and get more physical activity. Addressing these issues as early as possible in a pediatric patient’s life will make healthy behaviors more likely to become lifelong habits, adopted well before the damage is done.” Further, added Dr. Maahs, more research is needed to explore potential benefits of adjunctive therapies, including Metformin, GLP1 agonists and SGLT2 inhibitors, which have been shown to lower HbA1c levels and body weight in adults with type 2 diabetes. Benchmarking Type 1 Diabetes Issues in the International Community This study is one of several comparing data from the T1D Exchange Clinic Registry with the DPV registry. In addition to investigating BMI among pediatric patients, researchers have also explored glycemic control; the relationship between smoking and metabolic control; and the use of non-insulin medications. “International data comparisons enable researchers to benchmark key healthcare issues facing the global type 1 diabetes community. This kind of study also helps clinicians and researchers compare outcomes and utilize the findings to eventually improve standards of care in diabetes treatment and management,” said Henry Anhalt, DO, chief medical officer at T1D Exchange. Founded in 2009, T1D Exchange is a nonprofit that, for the first time, actively convenes all parties—patients, researchers, clinicians and industry—in the process of development, with the focus on advancing clinical and translational research to improve patient outcomes. Drawing on decades of research and data that have come before, T1D Exchange aims to be the translational engine that enables the entire type 1 diabetes ecosystem to collaborate in truly novel ways via the integration of its Clinic Network of 250 investigators at over 75 sites who follow more than 100,000 patients; a well-characterized Clinic Registry comprised of more than 27,000 individuals with type 1 diabetes; a Biobank, a repository of thousands of patient biosamples; and Glu, an active online community of more than 13,500 patients and caregivers. This study was funded by The Leona M. and Harry B. Helmsley Charitable Trust, the German BMBF Competence Net Diabetes Mellitus (which is integrated into the German Center for Diabetes Research (DZD) as of January 2015) and the European Foundation for the Study of Diabetes.