Increasing Rates of Metabolic Syndrome Seen in Children With T1D

Findings of a systematic review published in Nutrients highlight increased rates of metabolic syndrome (MetS), overweight, and obesity among children with type 1 diabetes (T1D). Combined, these conditions pose significant health problems to this at-risk population.

“Apart from the growing percentage of overweight and obese children and adolescents with T1D (on average 20.1% and 9.5%, respectively), the problem of the increasing incidence of MetS (range from 3.2% to 29.9%, depending on the criteria used) is one of the most important phenomena of our time,” researchers wrote.

Prevalence of T1D has been increasing as approximately 130,000 new cases are diagnosed each year. Worldwide, more than 1.1 million children and adolescents under the age of 20 years are affected by the disease.

MetS, defined as a set of physiological, metabolic, and biochemical factors, directly increases the risk of atherosclerotic cardiovascular diseases (CVD), which should be prevented in all individuals with diabetes.

The incidence of MetS is well documented in adult populations and over the past decade, certain components of the syndrome have begun to appear in youths with T1D. However, “despite strictly defined criteria in the adult population, in children, there are no homogeneous and objective criteria for the diagnosis of MetS,” authors wrote.

To conduct the systematic overview, researchers conducted a search on PubMed, Scopus, Web of Science and Cochrane Library in May 2020. All studies included in the final analysis (n = 9) were conducted on adolescents under the age of 21 and were published in English.

Of the studies included, 6 were conducted in Europe, 2 in Asia, and 1 in Africa, and together they included 1847 patients. Due to different criteria used, researchers found it challenging to estimate incidence of MetS. However, the review found:

• MetS was observed in 90 girls (76 according to the International Diabetes Federation [IDF] criterion, 14 according to the Adult Treatment Panel) and in 52 boys (40 and 12, respectively)
• Obesity was experienced on average by 9.5% (range, 3.9–14.6%) of the patients, and 20.1% (range, 9.5–29.3%) were overweight.
• Average glycated hemoglobin (A1C) value was 8.5% (range, 8–9.4%)
• Abdominal obesity was found in 232 people (14.7% of the entire study population that took the criterion into account), low high-density lipoprotein (HDL) levels in 234 (14.9%), and high triglycerides and blood pressure in 201 (12.8%) and 224 (12.6%), respectively.

Excessive consumption of high-energy food, such as liquid glucose, sweet beverages, or candy, for fear of hypoglycemia may explain increased rates of overweight and obesity in this population, authors explained.

“Moreover, insulin is an anabolic hormone and, if secreted in excess, can stimulate the appetite, which in the long term may result in weight gain,” researchers wrote. “Thus, the longer the duration of diabetes, poor metabolic control (high A1C) and high insulin resistance, the greater the predisposition to overweight or obesity.”

Despite the range of results yielded by the systematic review, authors noted percentages reported are still very high.

According to criteria from the IDF, MetS should not be diagnosed in children under the age of 10, posing a challenge to understanding this syndrome in children. Yet, when present, MetS parameters are linked with a number of health complications, while obesity alone is associated with an increased need for insulin and worse metabolic control.

In addition, “adolescents with T1D are predisposed to cardiometabolic complications, often regardless of body weight but, worryingly, their development of obesity can sometimes result in the development of ‘double diabetes’ with type 2 diabetes mellitus (T2D).”

To prevent and treat MetS, researchers suggested a number of potential interventions including promoting a healthy lifestyle through a balanced diet, improving quality and duration of sleep, and increasing moderate physical activity.

Overall, results of the review point to gaps in the literature regarding increasing prevalence of MetS in children with T1D and emphasize the need for further research in this area.

Research has shown that “obesity-related complications have become a very common phenomenon in the pediatric population, which underlines the urgent need to create a new definition of MetS to assist in the early diagnosis and prevention of cardiometabolic disorders,” authors concluded. “It would be important to develop additional and better MetS markers to enrich diagnostics, thus helping clinicians recognize the warning signs in time.”

Reference

Grabia M, Markiewicz-Żukowska R, Socha K. Prevalence of metabolic syndrome in children and adolescents with type 1 diabetes mellitus and possibilities of prevention and treatment: a systematic review. Nutrients. Published online May 23, 2021. doi:10.3390/nu13061782