Complications of obesity in children and youths with type 1 diabetes mellitus

Introduction
Excess body weight has a negative impact on the management of type 1 diabetes (T1D) and is an additional risk factor for the development of chronic vascular complications, insulin resistance and metabolic dysfunction-associated fatty liver disease (MAFLD). We compared and analyzed metabolic control, the incidence of insulin resistance and MAFLD in children and youths with T1D and excessive body weight (T1D-E) and those with T1D and normal body weight (T1D-N).

Material and methods
The study included 32 patients with T1D-N and 31 patients with T1D-E. Daily insulin requirement, estimated glucose disposal rate (eGDR1, eGDR2), HbA1C%, lipid profile, vitamin D level, cIMT value, and MAFLD prevalence were compared in relation to body mass index (BMI) and BMI SD score (BMI-SDS).

Results
T1D-E patients compared to T1D-N had higher systolic (125.58 ±8.18 vs. 120.16 ±10.02 mmHg, p = 0.022) and diastolic blood pressure (78.19 ±7.03 vs. 73.94 ±7.95 mmHg, p = 0.028), triglyceride levels (118.19 ±71.20 vs. 71.31 ±18.76 mg/dl, p = 0.001) and waist circumference (p < 0.001). Lower eGDR values were noted in T1D-E vs. T1D-N: eGDR1: 5.16 ±1.33 vs. 6.96 ±1.32; eGDR2: 9.37 ±1.21 vs. 10.66 ±0.9 (p = 0.0001, p = 0.0001). Vitamin D levels were lower and the incidence of MAFLD was higher in the T1D-E group (13% vs. 0%, p = 0.014). Patients with MAFLD had worse lipid profile results and higher cIMT values (0.48 vs. 0.43 mm, p = 0.4).

Conclusions
Excessive body weight in patients with T1D leads to elevated blood pressure, dyslipidemia, and insulin resistance, and increases the risk of MAFLD. Patients with MAFLD have a higher future cardiovascular risk, expressed as an increased cIMT value.