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COMMENTS AND RESPONSES Strong Association Between Time Watching Television and Blood Glucose Control in Children and Adolescents With Type 1 Diabetes Response to Margeirsdottir et al.
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e reply to Margeirsdottir et al. (1), reporting our experience in 237 type 1 diabetic Italian patients (139 male), aged (mean ⫾ SD) 16.8 ⫾ 7.1 years (range 1.8 –36.3) with mean disease duration 9.0 ⫾ 6.3 years (1.0 –27.6), mean A1C 7.7 ⫾ 1.1% (5.2– 13.5), and mean insulin requirement 0.82 ⫾ 0.24 units 䡠 kg⫺1 䡠 day⫺1 (0.24 – 1.58). Between January and March 2007, in all patients we evaluated by direct or telephone interviews the influence of leisure time in TV watching and computer use, daily snacking, and weekly hours of exercise. Moreover, degree of metabolic control, BMI SD score, and insulin requirement were considered. Six patients (2.5%) watched TV ⬍1 h/day (mean A1C 7.2 ⫾ 0.6%), 55 patients (23.2%) watched TV 1–2 h/day (mean A1C 7.1 ⫾ 0.7%), 67 patients (28.3%) watched TV 2–3 h/day (mean A1C 7.4 ⫾
0.8%), 78 patients (32.9%) watched TV 3– 4 h/day (mean A1C 8.0 ⫾ 1.2%), and 31 patients (13.1%) watched TV ⬎4 h/day (mean A1C 8.9 ⫾ 1.3%). In our Italian patients, A1C levels were positively related to hours of TV watching (P ⬍ 0.001) and to frequency of snacking (P ⬍ 0.0001). On the contrary, time spent using the computer did not significantly influence degree of metabolic control. Like Margeirsdottir et al., we found no significant correlation between A1C levels and time for exercise (1). BMI SD score was higher in patients watching TV ⱖ2 h/day (n ⫽ 176; 74.3%) than in the remaining patients (P ⫽ 0.01). These data could be explained by the lower energy expenditure and snacking behavior due to TV watching (1). Moreover, TV watching can easily be accompanied by eating, and the frequent food-related advertisements designed to invoke feelings of hunger may result in higher food intake (2). Computer use keeps both hands occupied and is not accompanied by food advertisements and is therefore less prone to induce snacking (2). In healthy schoolchildren, TV watching is associated with soft drink consumption (2) and increased BMI (3), and sedentary behavior raises the risk of obesity and type 2 diabetes. Our results confirm the association between time spent watching TV and poor metabolic control, increased BMI SD score, and insulin requirement—factors associated with higher cardiovascular risk. In young type 1 diabetic patients, a careful educational intervention aimed to avoid excess TV watching and junk food intake is mandatory in order to fight insulin resistance and metabolic syndrome—also recently reported in type 1
DIABETES CARE, VOLUME 30, NUMBER 12, DECEMBER 2007
diabetes and characterizing so-called “double diabetes” (4). ALESSANDRO GIANNATTASIO, MD1 FRANCESCA LUGANI, MD1, ANGELA PISTORIO, MD, PHD2 NICOLA MINUTO, MD1 RENATA LORINI, MD1 GIUSEPPE D’ANNUNZIO, MD1 From the 1Pediatric Clinic, University of Genoa, Regional Center for Pediatric Diabetes, Genoa, Italy; and the 2Epidemiology and Biostatistic Unit, IRCCS G. Gaslini, Genoa, Italy. Address correspondence to Giuseppe d’Annunzio, MD, Pediatric Clinic, G. Gaslini Institute, Largo Gaslini 5, 16147, Genova, Italy. E-mail:
[email protected]. DOI: 10.2337/dc07-1134 © 2007 by the American Diabetes Association. ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●
References 1. Margeirsdottir HD, Larsen JR, Brunborg C, Sandvik L, Dahl-Jorgensen K, for the Norwegian Study Group for Childhood Diabetes: Strong association between time watching television and blood glucose control in children and adolescents with type 1 diabetes. Diabetes Care 30:1567– 1570, 2007 2. Giammattei J, Blix G, Marshak HH, Wollitzer AO, Pettitt DJ: Television watching and soft drink consumption: associations with obesity in 11- to 13-year-old schoolchildren. Arch Pediatr Adolesc Med 157: 882– 886, 2003 3. Kaur H, Choi WS, Mayo MS, Harris KJ: Duration of television watching is associated with increased body mass index. J Pediatr 143:506 –511, 2003 4. Kilpatrick ES, Rigby AS, Atkin SL: Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: “double diabetes” in the Diabetes Control and Complications Trial. Diabetes Care 30:707–712, 2007
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