Dayal Devi, Samprathi Madhusudan, Jayaraman Dhaarani, Kohat Dilesh, Bhalla Anil Kumar
Paediatric Endocrinology & Diabetes Unit, Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Clin Endocrinol (Oxf). 2016 Mar;84(3):338-41. doi: 10.1111/cen.12941. Epub 2015 Oct 2.
The accelerator hypothesis, which proposes a link between Type 1 diabetes (T1D) and Type 2 diabetes (T2D) through weight-related insulin resistance, remains untested in developing countries with increasing rates of childhood obesity and T1D, and different ethnicities. We aimed to test the accelerator hypothesis in the context of a significant increase in T1D at our centre.
Medical records of children diagnosed with T1D between January 2005 and December 2014 were retrospectively reviewed. The body mass index (BMI) standard deviation scores (SDSs) were calculated using height and weight measurements recorded 1-2 months after diagnosis of T1D and compared with age-matched anthropometric data. The rate of change in BMI SDSs over time was calculated. Analysis of BMI data was undertaken for the three age categories: <5, 5 to <10 and >10 years.
The mean age at diagnosis of 467 children with T1D was 7·27 ± 0·32 years and showed no change over the study period. There was a yearly increase of 14·11% in patient numbers; this increase was similar in the three age categories (22·7%, 17·0%, 16·3%, respectively, P = 1·0). Comparison of patient numbers between the two time periods of 5 years each showed a marked increase during 2010-2014 (148 vs 319, % increase 115·5%). The mean BMI SDSs at diagnosis in the three age categories were similar (P = 1·0) and showed a yearly change of -0·36; the mean change in the three age categories was also similar (-0·35, -0·27, -0·46, respectively, P = 1·0). No correlation was found between age at diagnosis and BMI SDSs (correlation coefficient 0·010, P = 0·82). The mean BMI SDS in patients was significantly lower compared to controls (-0·54 vs -0·02, P = 0·001).
There was no association between BMI SDS and age at diagnosis in children with new onset T1D. Further studies are needed to test whether the accelerator hypothesis is relevant in developing countries.
加速假说提出1型糖尿病（T1D）与2型糖尿病（T2D）之间通过与体重相关的胰岛素抵抗存在联系，在儿童肥胖率和T1D发病率不断上升且存在不同种族的发展中国家，这一假说仍未得到验证。我们旨在在本中心T1D显著增加的背景下验证加速假说。
回顾性分析2005年1月至2014年12月期间诊断为T1D的儿童的病历。使用T1D诊断后1 - 2个月记录的身高和体重测量值计算体重指数（BMI）标准差评分（SDS），并与年龄匹配的人体测量数据进行比较。计算BMI SDS随时间的变化率。对三个年龄组（<5岁、5至<10岁和>10岁）的BMI数据进行分析。
467例T1D患儿的诊断平均年龄为7.27±0.32岁，在研究期间无变化。患者数量每年增加14.11%；三个年龄组的增加情况相似（分别为22.7%、17.0%、16.3%，P = 1.0）。对每5年的两个时间段的患者数量进行比较，结果显示2010 - 2014年期间有显著增加（148例对319例，增加百分比为115.5%）。三个年龄组诊断时的平均BMI SDS相似（P = 1.0），且每年变化为 - 0.36；三个年龄组的平均变化也相似（分别为 - 0.35、 - 0.27、 - 0.46，P = 1.0）。未发现诊断年龄与BMI SDS之间存在相关性（相关系数0.010，P = 0.82）。患者的平均BMI SDS显著低于对照组（ - 0.54对 - 0.02，P = 0.001）。
新诊断的T1D患儿中，BMI SDS与诊断年龄之间无关联。需要进一步研究以验证加速假说在发展中国家是否适用。
