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
糖尿病足的预防是各种指南中最重要的部分，无论是国内还是国外的，在各版的IWGDF指南都是重要内容，而且说明得特别详细及有比较多得循证医学的证据支持。但比较几个版本的IWGDF指南及国内外其他指南，这部分是肯定存在的，从中可以看出“糖尿病足的预防”已经深入人心。
糖尿病足实质上就是一种糖尿病人足部出现难以愈合的皮肤慢性溃疡，如何使糖尿病人足部皮肤慢性溃疡愈合是糖尿病足治疗的中心，因此，围绕足部皮肤慢性溃疡愈合是糖尿病足治疗的中心环节。
IWGDF（The International Working Group on the Diabetic Foot）是一个以欧美从事糖尿病足工作的专家为主的，有其他大洲有关专家共同组成的，目前国际上有关糖尿病足的预防、诊断、治疗、研究、管理等方面最专业的国际组织之一（基本上没有之一）。
脓腔切开，3型安尔碘纱布填塞一天之后，重新打开伤口，进行第二次清创，这次清创也是非常重要的。一般需要完成三个任务：探查创面、鉴别坏死及感染的组织、仔细清除各种需要清除的组织。
（3）要把足部被细菌侵袭的各个空隙最好都能打开，尤其是足部比较重要的“空隙”，也是为了引流充分。
糖尿病足的创面清创术是最有效的局部抗菌治疗。毛主席很早之前就教导我们：扫把不到灰尘照例不会自己跑掉，糖尿病足清创术就是治疗糖尿病足局部创面上的“灰尘”（细菌）最有效的“扫把”。
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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