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    Prevalence of obesity and metabolic syndrome in children with type 1 diabetes: A comparative assessment based on criteria established by the international diabetes federation, world health organisation and national cholesterol education program
    (Galenos Yayincilik, 2020) Koken, Ozlem Yayici; Kara, Cengiz; Yilmaz, Gulay Can; Aydin, Hasan Murat
    Objective: To determine the prevalence of obesity and metabolic syndrome (MetS) in children and adolescents with type I diabetes (TI D) and to compare the widely accepted and used diagnostic criteria for MetS established by the International Diabetes Federation UDR World Health Organisation (WHO) and National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATPIII). Methods: We conducted a descriptive, cross sectional study including T1D patients between 8-18 years of age. The three sets of criteria were used to determine the prevalence of MetS and findings compared. Risk factors related to MetS were extracted from hospital records. Results: The study included 200 patients with T1D (52 % boys). Of these, 18 % (n = 36) were overweight/obese (body mass index percentile 85%). MetS prevalence was 10.5 %, 8.5% and 13.5% according to IDF, WHO and NCEP criteria, respectively. There were no statistically significant differences in age, gender, family history of T1D and T2D, pubertal stage, duration of diabetes, hemoglobin Al c levels and daily insulin doses between patients with or without MetS. In the overweight or obese T1D patients, the prevalence of MetS was 44.4 %, 38.8% and 44.4% according to IDF, WHO and NCEP-ATPIII criteria, respectively. Conclusion: Obesity prevalence in the T1D cohort was similar to that of the healthy population of the same age. Prevalence of MetS was higher in children and adolescents with TI D compared to the obese population in Turkey. The WHO criteria include microvascular complications which are rare in childhood and the NCEP criteria do not include a primary criterion while diagnosing non-obese patients according to waist circumference as MetS because the existence of diabetes is considered as a direct criterion. Our study suggests that IDF criteria which allows the diagnosis of MetS with obesity and have accepted criteria for the childhood are more suitable for the diagnosis of MetS in children and adolescents with T1D.
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    Utility of estimated glucose disposal rate for predicting metabolic syndrome in children and adolescents with type-1 diabetes
    (Walter De Gruyter Gmbh, 2020) Koken, Ozlem Yayici; Kara, Cengiz; Yilmaz, Gulay Can; Aydin, Hasan Murat
    Objectives: To determine the clinical utility of the estimated glucose disposal rate (eGDR) for predicting metabolic syndrome (MetS) in children and adolescents with type-1 diabetes (T1D). Methods: Modified criteria of the International Diabetes Federation were used to determine MetS in children and adolescents between 10 and 18 years of age with T1D. The eGDR, a validated marker of insulin sensitivity, was calculated in two different ways using either the waist-to-hip ratio (WHR) or waist circumference (WC). Receiver operating characteristic (ROC) curve analysis was performed to ascertain cut-off levels of the eGDR to predict MetS. Results: A total of 200 patients (52% male) with T1D were enrolled in the study. The prevalence of MetS was 10.5% (n: 21). Lower eGDR levels, indicating greater insulin resistance, were found in T1D patients with MetS when compared to those without (6.41 +/- 1.86 vs. 9.50 +/- 1.34 mg/kg/min) (p < 0.001). An eGDR(WHR) cut-off of 8.44 mg/kg/min showed 85.7% sensitivity and 82.6% specificity, while an eGDR(WC) cut-off of 8.16 mg/kg/min showed 76.1% sensitivity and 92.1% specificity for MetS diagnosis. The diagnostic odds ratio was 28.6 (7.3-131.0) for the eGDR(WHR) cut-off and 37.7 (10.8-140.8) for the eGDR(WC) cut-off. Conclusions: The eGDR is a mathematical formula that can be used in clinical practice to detect the existence of MetS in children and adolescents with T1D using only the WC, existence of hypertension, and hemoglobin A1c levels. An eGDR calculated using the WC could be a preferred choice due to its higher diagnostic performance.