Sex differences in body composition in youth with type 1 diabetes and its predictive value in cardiovascular disease risk assessment

Seasonal Variations in HbA1c and Body Composition: A Sex-Specific Analysis in Adolescents With Type 1 Diabetes

BACKGROUND

Circannual fluctuations in glycated haemoglobin (HbA1c) levels are recognized among adults, but comparable changes and contributing factors in adolescents with type 1 diabetes (T1D) have not been investigated in depth.

OBJECTIVES

To examine the seasonal changes in HbA1c and their association with body composition in youth with T1D.

METHODS

This retrospective observational study included adolescents with T1D followed at our paediatric diabetes centre (2021-2023). Seasonal means were calculated for two periods (winter-spring: December to May and summer-autumn: June to November), and ΔHbA1c was calculated as the difference between the values. The patients' body composition (via bioelectrical impedance analysis (BIA)) data were reviewed, and correlation analyses were performed between sex- and age-adjusted z-scores of body composition components [appendicular muscle mass (ASMM) and fat mass (FATM)] and ΔHbA1c.

RESULTS

The seasonal means of HbA1c calculated for 259 adolescents with T1D (56% male, mean age: 16.01 ± 2.23 years) were significantly higher during winter-spring compared to summer-autumn (7.75% vs. 7.24%, p < 0.001, CI: 0.42-0.57), (61.16 mmol/mol vs. 55.72 mmol/mol, respectively p < 0.001, CI: 4.64-6.23). ΔHbA1c displayed a sex-specific association with body composition components in 102 patients (50% males) who underwent BIA. The correlation was significant for only ASMM z-scores in boys (r = 0.277, p = 0.049), while both the ASMM and FATM z-scores significantly correlated with ΔHbA1c (r = 0.301, p = 0.032 and r = 0.284, p = 0.043, respectively) in girls.

CONCLUSIONS

There is a seasonal variation in HbA1c levels in adolescents with T1D, with higher values during winter-spring. The link between seasonal variability and body composition components varied by sex, indicating a need for sex-specific strategies in adolescent diabetes management.

Body composition in a pediatric population with type-1 diabetes - The importance of planned physical exercise

OBJECTIVE AND METHODS

This study aimed to assess the body composition of pediatric patients with type-1 diabetes (T1D) in a Portuguese pediatric endocrinology/diabetic clinic, using the InBody 570 bioimpedance system. Preschool children (<6 years) and those recently diagnosed (<6 months) were excluded.

RESULTS

The study included 78 patients (53% female). Median age at assessment was 14 years, with 81% pubertal children. Eighty-seven percent were using continuous subcutaneous insulin infusion (CSII), 25% with an automated closed-loop model. Median HbA1c was 7.3%. Most had an adequate body mass index (BMI) standard deviation score (62%) and 48% engaged in regular physical exercise (PE) outside of school. Median percentage body fat (PBF) was 21.5% and was abnormal in 48%, with median visceral adiposity of 4. Despite adequate BMI, 11% had excessive PBF. PBF was significantly associated with visceral fat (r=0.79; P<0.001), female gender (P<0.001) and PE performed out of school (P=0.005). PE was associated with lower PBF (P=0.005), lower visceral fat (P=0.002), and higher muscle-to-fat ratio (P=0.006).

CONCLUSION

Engaging in physical exercise out of school correlated significantly with improved body composition, characterized by reduced PBF and diminished visceral adiposity. Considering the known benefits of physical exercise for metabolic and glycemic control, this study highlights the importance of promoting regular physical exercise in T1D patients.

Triglyceride-glucose index in adolescents with type 1 diabetes mellitus

BACKGROUND AND AIM

Even though HbA1c can be obtained easily and accurately by blood test, the cost may limit its availability for some patients and their proper follow-up. The triglyceride-glucose index has been shown to have an association with HbA1c in other populations, but it hasn't been studied in adolescents with T1DM yet. The aim of this study is to assess the association of TyG index with glycaemic control in adolescents with T1DM.

METHODS

This cross-sectional study included a sample of 36 adolescents (50% female) from the paediatric unit of the San Juan Hospital in Alicante (Spain). Data on sociodemographics, growth parameters, glycaemic control, and blood tests results were collected after routine visits.

RESULTS

A higher TyG index was statistically associated with a higher BMI, percentile and z-score, a higher triglyceride, HbA1c and glucose levels and with the triglycerides/HDL, the total cholesterol/HDL, the TyG-BMI and the TyG-waist circumference indexes.

CONCLUSION

The TyG index is a simple and non-invasive biomarker that could serve as a valuable adjunct to HbA1c monitoring in adolescents with T1DM. It may have a potential utility as a screening tool for early identification of patients at risk for developing metabolic complications such as insulin resistance and dyslipidemia.

Influence of Sex and Age on Irisin Levels in Pediatric Type 1 Diabetes: A Pilot Study

Background: Irisin is a myokine involved in the browning of adipocytes, the regulation of body composition and the enhancement of glycemic control. Additionally, irisin has been suggested to play a role in signaling mechanisms associated with the onset of puberty. In this study, we aimed to explore the interaction between muscle and adipose indices, urine irisin levels and glycemic control. Methods: This cross-sectional pilot study enrolled 76 consecutive pediatric patients (mean age 11.7 ± 3.8 years) diagnosed with type 1 diabetes (mean disease duration 2.1 ± 1.6 years). Body composition was assessed by bioelectrical impedance analysis (MFR z-score and skeletal muscle mass index). Urine irisin levels and glycemic control parameters (HbA1c, insulin dose-adjusted A1c [IDAA1c]) were evaluated. One linear regression model, stratified by sex, analyzed the sex-specific impact of puberty and age on irisin levels. A second linear regression model explored the associations of selected variables with irisin levels. Results: The first linear regression model revealed that irisin levels rise with age in prepubertal boys and decline with increased age among pubertal boys. The second linear regression analysis revealed no significant associations between irisin levels and metabolic parameters after adjusting for covariates. In contrast to boys, there were no significant interactions found in girls. Conclusions: Our novel findings revealed sex and age differences in the irisin levels of children and adolescents with type 1 diabetes. The dynamics underlying the role of irisin during pubertal development in the pediatric population with diabetes warrant further exploration.

Body composition in prepubertal children with idiopathic premature adrenarche: implications for cardiometabolic health

BACKGROUND

Premature adrenarche (PA) has been reported as a potential precursor of metabolic disease. We aimed to explore the interaction between body composition and cardiometabolic health of prepubertal children with PA.

METHODS

This observational study comprised of 87 children with PA (15 boys, 8.0 ± 1.2 years) and 87 healthy sex- and age-matched controls. Body composition was measured by bioelectrical impedance analysis.

RESULTS

Children with PA had a higher median BMI z-scores (P = 0.001), higher median fat percentage (P = 0.006), and lower muscle-to-fat z-scores (P = 0.050) compared to controls. There were no significant group differences in blood pressure percentiles and lipid profiles. Fat percentage of children with PA was positively correlated and the MFR z-score was negatively correlated with: BMI z-score, systolic blood pressure percentile, and atherogenic dyslipidemia index (P < 0.001 for all). There were significant correlations between parental and offspring MFR z-scores in the control group (father-child: r = 0.528, P = 0.020; mother-child: r = 0.359, P = 0.031), but none in the PA group.

CONCLUSIONS

Children with PA exhibited an unfavorable body composition in association with their metabolic health even before the onset of puberty. Furthermore, while healthy children displayed heritable body composition traits, children with PA did not, possibly suggesting a relatively greater role for environmental factors in the PA group.

IMPACT

Prepubertal children with premature adrenarche have a low muscle-to-fat ratio compared to healthy sex- and age- matched controls. The body composition of prepubertal children with premature adrenarche is associated with their systolic blood pressure percentile and atherogenic dyslipidemia index. Children with premature adrenarche and healthy weight exhibited higher adiposity compared to healthy weight controls, and those with overweight/obesity showed higher rates of elevated blood pressure and higher dyslipidemic atherogenic indices compared to overweight/obesity controls. These findings highlight the importance of early identification, intervention, and lifestyle changes for children with premature adrenarche to help prevent cardiometabolic complications.

The role of IGF1 in determining body composition in children and adolescents with growth hormone deficiency and those with idiopathic short stature

PURPOSE

Treatment with recombinant human growth hormone (rhGH) increases insulin growth factor-1 (IGF1) levels, therefore, monitoring both IGF1 and growth constitutes an acceptable parameter of therapeutic safety and efficacy. We aimed to investigate the relationship between IGF1 level and body composition in children and adolescents undergoing rhGH therapy for growth hormone deficiency (GHD) and idiopathic short stature (ISS).

METHODS

This observational retrospective study included the bioimpedance analysis (BIA) reports (n = 305) of 135 pediatric patients (age 5-18 years), 64 with GHD and 71 with ISS, conducted as part of routine clinic visits. Sociodemographic and clinical data were extracted from medical records. Generalized estimating equations linear models were used to explore the contributing factors for body composition components of fat percentage (FATP), appendicular skeletal muscle mass (ASMM) z-score, and muscle-to-fat ratio (MFR) z-score while adjusting for cumulative doses of rhGH.

RESULTS

Subjects with GHD exhibited higher body mass index z-scores (p < 0.001), higher FATP and truncal FATP scores, lower MFR z-score, and higher diastolic blood pressure percentiles than the ISS group (p = 0.010, p = 0.027, p = 0.050, and p = 0.050, respectively). Female sex (p < 0.001) and a GHD diagnosis (p < 0.001), were major contributors to higher FATP scores; female sex (p = 0.049) and ISS diagnosis (p = 0.005) were major contributors to higher MFR z-scores; and female sex (p < 0.001), older age (p < 0.001) and higher insulin-like growth factor 1 z-scores (p = 0.021) were major contributors to higher ASMM z-scores. Socioeconomic position and cumulative rhGH dose were not significant contributors to body composition parameters.

CONCLUSION

Children with GHD, including those undergoing rhGH treatment, may be at risk for increased adiposity and associated metabolic implications. Sex- and age-adjusted IGF1 levels were related to muscle mass but not to adiposity. Hence, rhGH treatment aimed at increasing IGF1 levels may alleviate these effects by promoting muscle growth.

Glucagon-like peptide-1 agonists: Role of the gut in hypoglycemia unawareness, and the rationale in type 1 diabetes

Type 1 diabetes is increasing and the majority of patients have poor glycemic control. Although advanced technology and nanoparticle use have greatly enhanced insulin delivery and glucose monitoring, weight gain and hypoglycemia remain major challenges and a constant source of concern for patients with type 1 diabetes. Type 1 diabetes shares some pathophysiology with type 2 diabetes, and an overlap has been reported. The above observation created great interest in glucagon-like peptide-1 receptor agonists (GLP-1) as adjuvants for type 1 diabetes. Previous trials confirmed the positive influence of GLP-1 agonists on β cell function. However, hypoglycemia unawareness and dysregulated glucagon response have been previously reported in patients with recurrent hypoglycemia using GLP-1 agonists. Jin et al found that the source of glucagon dysregulation due to GLP-1 agonists resides in the gut. Plausible explanations could be gut nervous system dysregulation or gut microbiota disruption. This review evaluates the potential of GLP-1 agonists in managing type 1 diabetes, particularly focusing on their impact on glycemic control, weight management, and glucagon dysregulation. We provide a broader insight into the problem of type 1 diabetes mellitus management in the light of recent findings and provide future research directions.

Body composition, metabolic syndrome, and lifestyle in treatment-naïve gender-diverse youth in Israel

BACKGROUND

There is a scarcity of published studies evaluating transgender/gender-diverse youth before initiating gender-affirming hormones.

AIM

To study the body composition, metabolic syndrome (MetS) components and lifestyle habits in treatment-naïve transgender youth.

METHODS

Cross-sectional study evaluating 153 transgender youth [median age 15.7 years, 94 transgender males] who attended The Israeli Children and Adolescents Gender Clinic between 6/2021-12/2022. Clinical, metabolic data and lifestyle habits (diet, physical activity and sleep patterns) were retrieved from the medical files. Body composition was determined by bioelectrical impedance analysis. Body mass index and muscle-to-fat ratio z-scores were calculated by sex designated at birth.

RESULTS

Weight categories differed between genders, with a greater proportion of subjects classified as underweight among transgender females, and a greater proportion affected by overweight/obese/severe obese among transgender males (p = 0.035). The odds for MetS components were increased by 2.2 for every 1 standard deviation decrease in the muscle-to-fat ratio z-score (95%CI: 1.45 to 3.26, p < 0.001). About one-third of the cohort did not meet any of the three lifestyle recommendations. Transgender males had increased odds for MetS components by 3.49 (95%CI: 1.63 to 7.44, p = 0.001).

CONCLUSIONS

Treatment-naïve transgender-male adolescents have an imbalance between muscle and adipose tissue, which places them at increased susceptibility for MetS components even prior to hormonal treatment.

Impact of Preeclampsia and Parity on Sex-based Discrepancies in Subclinical Carotid Atherosclerosis in Type 1 Diabetes

CONTEXT

The excess risk of fatal and nonfatal cardiovascular events is roughly twice as high in women than in men with type 1 diabetes.

OBJECTIVE

To evaluate the impact of preeclampsia and parity on sex-based discrepancies in preclinical atherosclerosis and on the diagnostic performance of a cardiovascular risk scale.

DESIGN

Cross-sectional study.

SETTING

Single tertiary hospital.

PATIENTS

A total of 728 people with type 1 diabetes (48.5% women) without cardiovascular disease and age ≥40 years, nephropathy, and/or ≥10 years of diabetes duration with another risk factor.

INTERVENTION

Standardized carotid ultrasonography.

MAIN OUTCOME MEASURES

Carotid plaque determined by ultrasonography and cardiovascular risk estimated according to the Steno T1 Risk Engine (Steno-Risk).

RESULTS

Nulliparous women and parous women without previous preeclampsia had a lower risk for carotid plaque than men (adjusted odds ratio: .48, 95% confidence interval [.28-.82]; adjusted odds ratio: .51 [.33-.79], respectively), without differences in the preeclampsia group. The prevalence of carotid plaque increased as the estimated cardiovascular risk increased in all subgroups except for preeclampsia group. The area under the curve of the Steno-Risk for identifying ≥2 carotid plaques was lower in the preeclampsia group (men: .7886; nulliparous women: .9026; women without preeclampsia: .8230; preeclampsia group: .7841; P between groups = .042). Neither the addition of parity nor preeclampsia in the Steno-Risk led to a statistically significant increase in the area under the curve.

CONCLUSION

The risk for carotid plaque in women compared with men decreased as exposure to obstetric factors diminished. However, the addition of these factors did not improve the prediction of the Steno-Risk.

Body Composition and Metabolic Syndrome Components in Transgender/Gender Diverse Adolescents and Young Adults

Purpose: The objective of this study was to examine the association of designated sex at birth, body composition, and gender-affirming hormone treatment (GAHT) with the components of metabolic syndrome (MetS) (overweight/obesity, elevated blood pressure [BP], altered glucose metabolism, and dyslipidemia) in transgender/gender diverse (TGD) adolescents and young adults. Methods: TGD individuals underwent body composition studies by bioelectrical impedance analysis according to designated sex at birth, and their muscle-to-fat ratio (MFR) z-scores were calculated. Generalized estimating equations with binary logistic models (n = 326) were used to explore associations while adjusting for potential confounders. Results: A total of 55 TGD females and 111 TGD males, with mean age of 18 ± 1.9 years and median duration of GAHT of 1.4 years (interquartile range = 0.6-2.5), were enrolled. Overall, 118/166 (71%) of the TGD cohort showed evidence of at least one MetS component, with a significantly higher rate among TGD males compared with TGD females (91.1% vs. 50.9%, p < 0.001). TGD males were at increased odds for overweight/obesity, elevated/hypertensive BP, elevated triglycerides (TGs), and an atherogenic dyslipidemia index (TG/high-density lipoprotein cholesterol [HDL-c], TG:HDL-c). The odds of overweight/obesity increased by 44.9 for each standard deviation decrease in the MFR z-score, while the odds for an elevated TG:HDL-c index increased by 3.7. Psychiatric morbidity increased the odds for overweight/obesity by 2.89. Conclusions: After considering confounding variables, the TGD males on GAHT were found to be at an increased risk for cardiometabolic disease. Our observations support the importance of targeted medical nutrition intervention in this group of individuals.

The role of sex on the prevalence of cardiovascular risk factors in children and adolescents with Type 1 diabetes: The SWEET international database

OBJECTIVE

To assess the prevalence of cardiovascular risk factors (CVRFs) in children and adolescents with type 1 diabetes (T1D) in the International SWEET registry and the possible role of clinical variables in modifying the risk of having single or multiple CVRFs.

STUDY DESIGN

The study is a cross-sectional study. Cut-off points for CVRFs were fixed according to International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines and WHO parameters: LDL cholesterol (LDL-C) > 100 mg/dL; Systolic Blood Pressure (BP-SDS) > 90th percentile for sex, age, and height; BMI-SDS > 2SD for sex and age. Logistic regression models were applied to evaluate variables associated with at least 1 or 2 CVRFs among registry children and adolescents.

RESULTS

29,649 individuals with T1D (6-18 years, T1D ≥ 2 years) participating in the SWEET prospective multicenter diabetes registry were included. In the cohort, 41 % had one or more CVRFs, and 10 % had two or more CVRFs. Thirty-five percent of enrolled individuals had LDL-C > 100 mg/dL, 26 % had BMI-SDS > 2SD, and 17 % had Systolic BP-SDS > 90th percentile. Females had higher frequency than males of having 1 or 2 CVRFs (45.1 % vs 37.4 %, 11.8 % vs 7.8 %; p < 0.001). Multivariable logistic regression models showed that sex (female), HbA1c category (>7.0 %), and age (>10 years) were associated with a higher chance of having at least 1 or 2 CVRFs (p < 0.001).

CONCLUSIONS

In children and adolescents with T1D, female sex, in addition to HbA1c above 7 %, and older age (>10 years) was associated with a higher risk of having at least a CVRF (LDL-C, BMI-SDS, BP) according to internationally defined cut-offs.

Muscle-to-fat ratio in children and adolescents with type 1 diabetes in predicting glycaemic control and partial clinical remission

BACKGROUND

Advances in treatment could mitigate the expected adverse changes in the body composition of children and adolescents with type 1 diabetes (T1D).

OBJECTIVES

To examine the evolution of weight status and body composition and their association with glycaemic control and partial clinical remission in youth with T1D.

METHODS

Ninety-nine participants with T1D (median age 9.5 years [interquartile range 7.3, 12.9], 59.6% boys) were longitudinally followed for 3 years since diagnosis. Data at seven pre-determined time points were extracted from medical files. Outcome measures included body mass index (BMI) z-scores, muscle-to-fat ratio (MFR) z-scores, haemoglobin A1c (HbA1c) levels, continuous glucose monitoring metrics, and insulin dose-adjusted HbA1c (IDAA1c) levels.

RESULTS

The BMI z-scores increased significantly (p < 0.001) for both sexes, with no significant change in MFR z-scores over time. The girls had higher BMI z-scores (p < 0.001) and lower MFR z-scores than the boys (p = 0.016). The mean HbA1c levels decreased during the first month and at 3 months since diagnosis (p < 0.001), then plateaued and achieved a median overall HbA1c of 7.1% for the entire cohort. At 12 months, 37 participants (37.6%) were in partial clinical remission, as evidenced by IDAA1c ≤ 9. The odds of partial clinical remission at 2 years increased by 2.1-fold for each standard deviation increase in the MFR z-score (p < 0.001). Higher MFR z-scores were associated with better metabolic control.

CONCLUSIONS

Integration of body composition assessments could mitigate adverse body changes in paediatric patients with T1D.

Fat-to-muscle ratio is associated with insulin resistance and cardiometabolic disorders in adults with type 1 diabetes mellitus

AIMS

This study aimed to investigate the correlation of the fat-to-muscle ratio (FMR) with insulin resistance (IR) and cardiometabolic disorders (CMD) in patients with type 1 diabetes mellitus (T1DM).

MATERIALS AND METHODS

We retrospectively recruited 420 adults with T1DM [52.6% men, median age 32.4 (24.5, 43.0) years]. Body composition was assessed by bioelectrical impedance analysis and FMR was calculated. The characteristics of the overall participants were compared between tertiles of FMR. Logistic regression analyses were performed to assess the association of FMR tertiles with IR and cardiometabolic risk factors.

RESULTS

Median age and median haemoglobin A1c of all participants were 32.4 (24.5, 43.0) years and 7.4 (6.5, 8.7)%, respectively. The prevalence of IR and CMD was 18% and 38.6%. The FMR significantly differed between men and women [0.39 (0.31, 0.53) vs. 0.74 (0.63, 0.92), respectively, p < .001]. The proportion of IR and CMD gradually increased as the FMR increased. The multivariable-adjusted odd ratios for IR and CMD in FMR tertile 3 compared with tertile 1 were 4.8 [95% confidence interval (CI): (1.9, 12.1)] and 9.7 (95% CI: 4.2, 22.3), respectively, in men. For women, the corresponding odd ratios were 4.0 (95% CI: 1.2, 12.9) for IR and 5.8 (95% CI: 2.4, 13.6) for CMD.

CONCLUSIONS

FMR is associated with IR and CMD in adults with T1DM and could be used as a promising parameter for targeting treatment in T1DM.