Ann Pediatr Endocrinol Metab.  2015 Jun;20(2):92-97. 10.6065/apem.2015.20.2.92.

Preserved C-peptide levels in overweight or obese compared with underweight children upon diagnosis of type 1 diabetes mellitus

• Yu HW
• Lee YJ
• Cho WI
• Lee YA
• Shin CH
• Yang SW

• KMID: 2368992
• DOI: http://doi.org/10.6065/apem.2015.20.2.92

Abstract

PURPOSE
We hypothesized that overweight or obese children might develop type 1 diabetes mellitus (T1DM) early despite residual beta-cell function. Factors independently associated with preservation of C-peptide level were analyzed.
METHODS
We retrospectively reviewed the medical data of 135 children aged 2.1-16.5 years with autoimmune T1DM. Body mass index (BMI), pubertal stage, and glycosylated hemoglobin (HbA1c) and C-peptide levels were evaluated. Patients were assigned to underweight (22.2%), normal weight (63.7%), and overweight or obese (14.1%) groups according to their BMI.
RESULTS
Preservation of serum C-peptide levels (> or =0.6 ng/mL) was found in 43.0% of subjects. With increasing BMI, the proportions of children with preserved C-peptide levels increased from 33.3% to 41.9% to 63.2%, with marginal significance (P=0.051). Interaction analysis indicated no effect of BMI score on age at onset associated with serum C-peptide levels. The lower the C-peptide level, the younger the age of onset (P<0.001), after adjustment for BMI z-score and HbA1c level. However, no significant relationship between BMI z-score or category and onset age was evident. Upon multivariate-adjusted modeling, the odds that the C-peptide level was preserved increased by 1.2 fold (P=0.001) per year of life, by 3.1 folds (P=0.015) in children presenting without (compared to with) ketoacidosis, and by 5.0 folds (P=0.042) in overweight or obese (compared to underweight) children.
CONCLUSION
Overweight or obese children had slightly more residual beta-cell function than did underweight children. However, we found no evidence that obesity temporally accelerates T1DM presentation.

Keyword

Type 1 diabetes mellitus; C-peptide; Body mass index; Obesity; Age of onset

MeSH Terms

Age of Onset
Body Mass Index
C-Peptide*
Child*
Diabetes Mellitus, Type 1*
Diagnosis*
Hemoglobin A, Glycosylated
Humans
Ketosis
Obesity
Overweight*
Retrospective Studies
Thinness*
C-Peptide

Figure

• 

  Fig. 1 The proportions of preserved C-peptide levels and the odds of such preservation by body mass index (BMI) category. (A) As BMI category increased from underweight, to normal weight, to overweight or obese, the proportions of children with preserved C-peptide levels increased from 33.3%, to 41.9%, to 63.2%, respectively, with marginal significance (P=0.051). (B) In the final multivariate logistic regression model, the odds of C-peptide preservation increased 1.9 fold (P=0.325) in normal weight and 5.0 folds (P=0.042) in overweight or obese children compared with underweight children.

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