Stefan Särnblad

Increased prevalence of overweight in adolescent girls with type 1 diabetes mellitus

Height and weight were measured in young patients with type 1 diabetes up to the age of 22 y. We found no difference between birth length standard deviation scores (SDS), final height SDS and target height SDS. The study group of 89 diabetic boys and girls did not differ in final height from age‐ and sex‐matched healthy controls. SDS for height at diagnosis, +0.17 ± 1.10, exceeded that for final height, −0.06 ±0.97 (p = 0.037). Height SDS decreased between the ages of 11 and 18 (p <0.01). In diabetic girls, but not boys, final height SDS was significantly related to mean HbA1c during puberty (r=−0.40; p = 0.025). Weight gain occurred from age of menarche in girls with type 1 diabetes. At the age of 18, diabetic girls were 6.5 kg heavier and had 2.7 kg/m2 higher body mass index (BMI) than control girls (p<0.001). Diabetic boys were not heavier than control boys. There was a significant relationship between mean HbA1c during puberty and BMI at the age of 18 in diabetic girls (r= 0.47; p = 0.009). In diabetic females, body weight remained unchanged, HbA1c improved and the dose of insulin was significantly reduced between 18 and 22 y of age. The HbA1c improvement was most marked in patients with poor metabolic control. In conclusion, although mean final height was normal in young patients with type 1 diabetes, growth was increased before diagnosis and pubertal growth spurt was reduced. Adolescent overweight was overrepresented; it related to poor metabolic control in females with diabetes, but showed no further acceleration in early adulthood.

Does physical activity equally predict gain in fat mass among obese and nonobese young adults

Background:Differences in energy metabolism and physical activity (PA) may contribute to the long-term regulation of body weight (BW).Objective:To examine the associations between metabolic determinants, energy expenditure and objectively measured components of PA with change in BW and fat mass (FM).Design:Prospective (4 years.), case–control study in obese (n=13) and normal weight (n=15) young adults.Measurements:At baseline, we measured resting metabolic rate, substrate oxidation, movement economy (ml O2 kg−1 min−1), aerobic fitness (VO2max), total and PA energy expenditure by doubly labelled water, and PA by accelerometry. Fat mass was measured by DXA. At follow-up we repeated our measurements of PA and FM.Results:Fat mass increased significantly (P<0.001) in both groups. Physical activity did not change between baseline and ‘follow up’. Change in overall PA (counts per minute) was inversely associated with change in BW and (β=−0.0124, P=0.054) and FM (β=−0.008, P=0.04). Post hoc analyses suggested that this association was explained by changes in the normal weight group only (β=−0.01; P=0.008; and β=−0.0097; P=0.009, for BW and FM, respectively). Metabolic determinants, energy expenditure estimates and subcomponents of PA (i.e. time spent at different intensity levels) were not significantly associated with change in BW or FM.Conclusion:Our results suggest an independent association between PA and FM. However, this association may differ depending on obesity status. The gain in FM, without any change in PA, may suggest that dietary intake is the major contributor to the positive energy balance.

Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: Results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS)

AIMS To evaluate the associations between physical activity (PA) and metabolic control, measured by glycated hemoglobin (HbA1c), in a large group of children and adolescents with type 1 diabetes. METHODS Cross-sectional analysis of data from 4655 patients, comparing HbA1c values with levels of physical activity. The data for the children and adolescents were obtained from the Swedish pediatric diabetes quality registry, SWEDIABKIDS. The patients were 7-18 years of age, had type 1 diabetes and were not in remission. Patients were grouped into five groups by frequency of PA. RESULTS Mean HbA1c level was higher in the least physically active groups (PA0: 8.8% ± 1.5 (72 ± 16 mmol/mol)) than in the most physically active groups (PA4: 7.7% ± 1.0 (60 ± 11 mmol/mol)) (p<0.001). An inverse dose-response association was found between PA and HbA1c (β: -0.30, 95% CI: -0.34 to -0.26, p<0.001). This association was found in both sexes and all age groups, apart from girls aged 7-10 years. Multiple regression analysis revealed that the relationship remained significant (β: -0.21, 95% CI: -0.25 to -0.18, p<0.001) when adjusted for possible confounding factors. CONCLUSIONS Physical activity seems to influence HbA1c levels in children and adolescents with type 1 diabetes. In clinical practice these patients should be recommended daily physical activity as a part of their treatment.

Diabetes management in Swedish schools: a national survey of attitudes of parents, children, and diabetes teams

Parents of children with type 1 diabetes often raise complaints about self‐care support during school time. The aim of this study was to investigate attitudes to diabetes care in school reported by children with type 1 diabetes, their parents, and their diabetes teams.

Improved diabetes management in Swedish schools : results from two national surveys

Support in diabetes self‐care in school is essential to achieve optimal school performance and metabolic control. Swedish legislation regulating support to children with chronic diseases was strengthened 2009.

Self‐care management of type 1 diabetes has improved in Swedish schools according to children and adolescents

Age‐appropriate support for diabetes self‐care is essential during school time, and we investigated the perceived quality of support children and adolescents received in 2015 and 2008.

Effect of Vitamin D supplementation on body composition and cardiorespiratory fitness in overweight men—a randomized controlled trial

PurposeSeveral observational studies have shown an association between vitamin D deficiency and non-skeletal major health issues including impaired cardiorespiratory fitness and adiposity. Only a few studies have examined the impact of vitamin D supplementation on these conditions and the results are ambiguous. The aim of this study was to examine the effect of vitamin D supplementation on body composition and cardiorespiratory fitness in overweight/obese men with vitamin D deficiency.MethodsThis study was a prospective, placebo controlled, double blinded, randomized trial with a study period of 6 months. Forty overweight/obese men (BMI > 25 kg/m2) with vitamin D deficiency (25(OH)D ≤ 55 nmol/L) were randomized to receive either 2000 IU Cholecalciferol drops or the equivalent amount of drops of placebo. At baseline and follow up body composition and cardiorespiratory fitness were measured and blood samples were obtained. Body composition was measured using bioelectrical impedance analysis (BIA) and cardiorespiratory fitness using cardiopulmonary exercise test (CPET). The primary outcomes were changes in percentage body fat and in maximum oxygen uptake (VO2max).ResultsNo statistically significant difference between the placebo and the intervention group regarding changes in percentage body fat (p = 0.54) and VO2max (p = 0.90) was observed. Moreover, there was no statistically significant difference between the groups concerning changes in BMI (p = 0.26), maximum load (p = 0.89) and oxygen uptake at anaerobic threshold (AT) (p = 0.14).ConclusionsWe conclude that treatment with 2000 IU/d vitamin D for 6 months does not impact body composition or maximum oxygen uptake in overweight/obese men with vitamin D deficiency.

0118: Cardiorespiratory responses to incremental exercise in type 1 diabetic patients: a comparison between patients with poor and good glycaemia control

Impaired cardiovascular responses were found in Type 1 diabetic patients (T1DM). Abnormal exercise electrocardiograms were also found in some T1DM, but to our knowledge, the effect of impaired control of blood glucose control on stroke volume and oxygen uptake responses during a graded cycling exercise has never been addressed. To investigate the effect of glycaemia control on exercise-induced cardiorespiratory responses, two young T1DM patients matched in terms of age (17-yr) and pubertal development and showing either a good (T1DM-G) or a poor (T1DM-P) control of blood glucose were recruited. They performed an incremental cycling exercise test until exhaustion to determine maximal tolerated power output (MTP), peak values of oxygen uptake (VO2peak), stroke volume (SV max ) and heart rate (HR max ). Blood glucose was measured 5-min before, at the end of exercise, and during passive recovery (6 and 15-min). The subjects showed similar blood glucose resting values. During exercise recovery, blood glucose value remained elevated in T1DM-P (9.3 at the end of exercise; 8.7mmol.L 1 after 15 th min of passive recovery), but it decreased from 7.9 to 4.7mmol.L –1 in T1DM-G. T1DM-G showed higher MTP than T1DM-P (4.6 vs. 3.2 w.kg –1 ). Furthermore, higher values of VO2peak (51.6 vs. 40.1mL.min –1 .kg –1 ) and HR max (209 vs. 175 bpm) were recorded for T1DM-G vs T1DM-P. From resting condition to the end of the exercise, SV was increased by 1.3-fold in TD1DM-G (68 to 89mL.beat –1 ) and 1.5-fold in T1DM-P (88 to 132mL.beat –1 ). Consequently, the maximal cardiac output value was slightly higher in T1DM-P compared to TD1DM-G, with similar maximal cardiac index (9.9 vs. 10.3 L.min.m -2 for TD1DM-G and T1DM-P, respectively). Altered control of blood glucose could have an impact on cardiorespiratory responses during progressive cycling exercise. Blood glucose recovery response, HR max and VO2peak rather than SV max or cardiac index seemed glycaemia control dependent.

Body fat measurement in adolescent girls with type 1 diabetes: a comparison of skinfold equations against dual-energy X-ray absorptiometry.

Skinfold measurement is an inexpensive and widely used technique for assessing the percentage of body fat (%BF). This study assessed the accuracy of prediction equations for %BF based on skinfold measurements compared to dual‐energy X‐ray absorptiometry (DXA) in girls with type 1 diabetes and healthy age‐matched controls.