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We read with interest the paper by Saxena et al who report differences in prevalence of overweight and obesity in children of different ethnic groups.1
The increased prevalence of overweight in adolescents with type 1 diabetes2 and among South Asian and Afro-Caribbean children with type 2 diabetes3 is well recognised. However, little information exists on the differences in obesity between white Caucasian and South Asian children with type 1 diabetes.
We conducted a retrospective analysis of the children with type 1 diabetes in our centre in Leicestershire, with an estimated proportion of South Asians in the city of Leicester of 28% (Census 2001). Our aim was to study the rates of obesity/overweight in white Caucasian and South Asian groups, and to correlate these with age, duration of diagnosis, daily insulin requirement, and HbA1c. We included children between the ages of 2 and 18 years and who had been diagnosed more than a year ago.
Data were collected for 150 children; 25% (38/150) of our study population were South Asians, with the remainder being white Caucasians. There were similar numbers of females and males represented (74 and 76 respectively).
Overall, 35% (n = 53) of children with type 1 diabetes in our centre were either overweight (>91st centile on BMI charts4), or obese (>95th centile), with 18% (n = 27) of the total being obese. This compared to 23% overweight and 6% obese, respectively, in the study by Saxena et al. None of the children under the age of 4 years were overweight/obese. All the other three age groups from our service showed a higher prevalence of obesity compared to the data from Saxena et al (table 1). There was no significant difference in the proportion of overweight (19% v 16%, p = 0.61) or obesity (16% v 20%, p = 0.57) between girls and boys.
There were no statistically significant differences in the rates of overweight or obesity between white Caucasian and South Asian children at any age grouping.
Furthermore, there was no significant difference in the two subgroups in relation to age, duration of diagnosis, daily insulin requirement, and metabolic control (median HbA1c 8.4% v 8.8% respectively).
In conclusion, just as there is a worrying high and increasing level of overweight and obesity in the general population,1 we have confirmed that this is an even greater problem in children and adolescents with diabetes in both our major ethnic groups. The concerns expressed by Saxena and colleagues1 are even greater in children with diabetes because of the adverse cardiovascular prognosis for young people with type 1 diabetes.5
The management of childhood diabetes needs to focus not only on glycaemic control but also on efforts to prevent excessive weight gain and to reduce other cardiovascular risk factors.
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