August 16, 2019

Obesity in children and young adults with Type 1 diabetes can lead to early cardiovascular complications in as few as 10 years following diabetes diagnosis, according to new research from the UNC Gillings School of Global Public Health.

Dr. Anna Kahkoska

Dr. Anna Kahkoska

Anna Kahkoska, PhD, a recent doctoral graduate in nutrition, is lead author of the paper, “Longitudinal phenotypes of Type 1 diabetes in youth based on weight and glycemia and their association with complications,” published July 10 in the Journal of Clinical Endocrinology & Metabolism. Kahkoska continues to take classes at UNC-Chapel Hill as part of her dual doctoral/medical degree.

Unlike Type 2 diabetes, Type 1 diabetes often presents in childhood and typically is not associated with being overweight. However, recent data show a rise in the prevalence of obesity among young people with Type 1 diabetes. Excess body weight has been linked with a higher risk of complications associated with diabetes, such as cardiovascular disease.

While there is a growing concern about the impact of obesity on health overall in the United States, there is a lack of research specific to how excess body weight impacts early health outcomes for young individuals with Type 1 diabetes, Kahkoska says.

In addition, an individual may be particularly impacted by complications based on their level of blood glucose control. For this reason, the research team took an approach that allowed them to consider how both weight status and glycemic control throughout childhood and young adulthood are associated with the emergence of diabetes complications.

“If you cluster the population of children and young adults with Type 1 diabetes based on their measures of body weight and level of glucose control over time, you find there are several significant patterns that these young people tend to follow in the first 10 years after diagnosis with Type 1 diabetes,” she says.

The study team evaluated 570 young people with Type 1 diabetes who were diagnosed between 2002 and 2008. Patients were clustered into groups based on body mass index (BMI) z-scores (which are adjusted for age and sex) and hemoglobin A1c tests, which show the average level of blood sugar over two-or-three months from baseline visits and follow-up visits that occurred an average of eight years later. The researchers tested for associations with seven early diabetes complications at follow-up. Different patient clusters clusters showed elevated odds of developing hypertension, hyperlipidemia, retinopathy and kidney disease.

“One of the most important findings was that excess body weight within the first 10 years after diagnosis may accelerate the rate at which children and young adults develop the complications that individuals with diabetes are already at risk of developing, in particular markers of early cardiovascular disease,” Kahkoska says.

The study authors conclude that knowing details about a patient’s weight status may provide useful information to better predict which children or young adults with Type 1 diabetes are at highest risk for developing early complications. In the future, providers may introduce conversations about obesity into their care of children and young adults with Type 1 diabetes, approaching it from medical and behavioral perspectives to help patients understand how obesity can be related to worsening glycemic control and the overall impact weight may have on preventable complications.

Dr. Elizabeth Mayer-Davis

Dr. Elizabeth Mayer-Davis

Kahkoska attributed the growing research and conversation about these concerns to the work of co-author Elizabeth Mayer-Davis, PhD, Cary C. Boshamer Distinguished Professor of Nutrition and Medicine and chair of the Department of Nutrition at the Gillings School. Mayer-Davis’ influence includes the formation of an interdisciplinary consortium called the Advance Care for Type 1 Diabetes and Obesity Network (ACTION), which brings together researchers from UNC, the Florida Hospital Translational Research Institute for Metabolism and Diabetes, and Stanford University’s Division of Pediatric Endocrinology and Diabetes.

“The ultimate vision is that we could identify people in the highest risk group much earlier in their disease,” says Kahkoska. “Then we could target interventions toward the specific needs of that subgroup to yield the best possible long-term outcomes.”

Other co-authors from the Gillings School include: Crystal Nguyen, PhD, graduate research assistant, and Michael Kosorok, PhD, W.R. Kenan Jr. Distinguished Professor and chair, both in the Department of Biostatistics; Linda Adair, PhD, professor, and Kyle Burger, PhD, RD, associate professor, both in the Department of Nutrition; and Allison Aiello, PhD, professor in the Department of Epidemiology.

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