Claudio Maffeis1 · Ilaria Fierri1 · Elisa Morotti1 · Erika Caiazza1 · Quincy Pedranzini1 · Marco Marigliano1 · Claudia Piona1
Received: 20 October 2025 / Accepted: 6 January 2026 / Published online: 31 January 2026 © The Author(s) 2026
Abstract
Aims To investigate the relationship between body adiposity and glycemic control in children and adolescents with type 1 diabetes (T1D).
Methods This cross-sectional study included 364 children and adolescents aged 6–18 years with T1D. Anthropometric indi-ces [BMI, BMI Z-score, waist-to-height ratio (WHtR)] and body composition [fat mass (FM), FM%, fat mass index (FMI)], assessed using bioelectrical impedance analysis, were obtained. Hemoglobin A1c and glucose sensor metrics, including time in range (TIR), were used to assess glycemic control. Associations between variables were analyzed using Spearman’s correlation. Logistic regression models were run to identify independent predictors of HbA1c<7.0% and TIR>70%, with FMI, WHtR, total daily insulin dose per kg (TDD), treatment modalities, sex, age, diabetes duration, and pubertal stage as independent variables.
Results Adiposity measures (FMI, FM%, and WHtR) were positively associated with HbA1c and negatively with TIR in both sexes. Logistic regression showed that HbA1c<7% and TIR>70% were significantly predicted by FMI [OR(95%CI): 0.822(0.704–0.960), p=0.013, and 0.807(0.681–0.955), p=0.012, respectively] and WHtR(x100) [OR(95%CI): 0.927(0.874– 0.983), p=0.013, and 0.923(0.866–0.985), p=0.015, respectively], independently of TDD, sex, treatment modalities and the other independent variables.
Conclusions Body adiposity negatively impacts glycemic control in children and adolescents with T1D, independent of sex and insulin treatment modalities. Despite technological advances in diabetes care, excess adiposity is emerging as a key modifiable factor associated with poorer glycemic outcomes and, consequently, poorer long-term health in children and adolescents with T1D.
Keywords Type 1 diabetes · Children · Body mass index · Adiposity · HbA1c · TIR
Abbreviations
ADA American Diabetes Association
AID Automated insulin delivery
BMI Body mass index
BP blood pressure
CGM Continuous glucose monitoring
Communicated by Annunziata Lapolla
Marco Marigliano
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1 Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University and Azienda Ospedaliera Universitaria Integrata of Verona, Piazzale Stefani, 1, Verona 37126, Italy
CVRFs Cardiovascular risk factors
FM Fat mass
FMI Fat mass index
GRI Glycemia risk index
HDL High-density lipoprotein cholesterol
IP Insulin Pump
ISPAD International Society for Pediatric and Adoles
cent Diabetes
LDL Low-density lipoprotein
MDI Multiple daily injection
PwD People with type 1 diabetes
TAR Time above range
TBR Time below range
TDD Total daily dose/kg of body weight
TG Triglycerides (TG)
TIR Time in range
T1D Type 1 diabetes
WC Waist circumference
WHtR Waist-to-height ratio
Alessia Gaglio1 · Yana Pigotskaya1 · Gabriele Rossi2 · Marco Mirani3 · Federico Giacchetti5 · Valeria Grancini1 · Valeria Maggi2 · Giovanna Mantovani1,4 · Irene Cetin2,4 · Emanuela Orsi5 · Veronica Resi1
Received: 21 November 2025 / Accepted: 17 January 2026
© The Author(s) 2026
Background Women with previous gestational diabetes mellitus (GDM) are at high risk of developing type 2 diabetes mel-litus (T2DM). Although early postpartum screening is recommended, metabolic changes occurring during the first year remain poorly characterized, and Italian guidelines do not include assessment at this time point.
Aim To evaluate glycaemic and metabolic changes one year after delivery in women with previous GDM and identify clini-cal and lifestyle predictors of postpartum glucose impairment.
Methods A cohort of 134 women with prior GDM was assessed at 6–12 weeks (T0) and one year postpartum (T1). Anthro-pometric, biochemical, nutritional, lifestyle, and quality-of-life parameters were collected. Dietary habits were evaluated using a 3-day food diary and the PREDIMED questionnaire; physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). Logistic regression models were used to identify predictors of altered OGTT at T1.
Results At baseline, 32.9% of women showed altered OGTT; this increased to 38.8% at one year, while T2DM prevalence rose from 2.2 to 5.2%. Insulin therapy during pregnancy was the only independent predictor of dysglycaemia at T1 (OR 3.5, 95% CI 1.28–9.50, p=0.015). Women with altered OGTT reported lower SF-36 scores in the domains “role limitations due to physical health” (p=0.016) and “health change” (p=0.030). Breastfeeding was associated with more favourable glucose outcomes (p=0.009).
Conclusions One-year follow-up after GDM reveals early metabolic and psychosocial differences not detectable in the early postpartum period. Insulin therapy during pregnancy strongly predicts glucose impairment, highlighting the need for extended postpartum surveillance and targeted lifestyle interventions.
Keywords Gestational diabetes · Postpartum follow-up · Impaired glucose tolerance · Lifestyle · Breastfeeding
Communicated by Annunziata Lapolla.
Alessia Gaglio
1 Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milan, Italy
2 Obstetric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
3 Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
4 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
5 Diabetology and Nutritional Unit, Department of Specialist Medicine, ASST Santi Paolo e Carlo, Milan, Italy
原创： 十六点五 中山二院糖尿病足中心
男性，24岁，3年前外院诊断“下丘脑生殖细胞瘤”，进行γ刀治疗后，长期应用“氢化可的松”早晚各2片维持，半年前不慎损伤左小腿下部外侧皮肤，之后长期不愈合，收入院。
含银的敷料是目前治疗糖尿病足的主流敷料，有各种剂型，包括泡沫状、胶冻态、液态、粉末态、膏态等等，生产的厂家的非常多，其中的质量良莠不齐，很难鉴别。
进一步的清创就到了骨骼，对于骨髓炎最彻底的治疗方法就是去除被细菌侵袭的骨，正常的骨骼一般是浅黄色，如果发白或者变黑，往往就提示这段骨头可能活性比较差，另外，还有一种是面积比较大的骨暴露，一般的肉芽组织很难爬上去，因此，对于坏死的骨头及较大面积的骨暴露，一般需要清除。
皮下组织中的脂肪组织在足部分布广泛，而皮下脂肪中血管分布非常少，在相对或绝对缺血的糖尿病足中，脂肪组织边缘的是否出血不是其是否存活的可靠指标。
这是一个我们在《糖尿病足切开设计（1）》中提到过，这次从不同角度谈谈足趾的保全。
大趾是足部最重要的结构，如果被切除，对足部的功能会有比较大的影响，因此，应该尽可能的保存。
伤口世界平台生态圈，以“关爱人间所有伤口患者”为愿景，连接、整合和拓展线上和线下的管理慢性伤口的资源，倡导远程、就近和居家管理慢性伤口，解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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