The Role of Age and Excess Body Mass Index in Progression to Type 1 Diabetes in At-Risk Adults.

The Role of Age and Excess Body Mass Index in Progression to Type 1 Diabetes in At-Risk Adults.

J Clin Endocrinol Metab. 2017 Oct 06;:

Authors: Ferrara CT, Geyer S, Evans-Molina C, Libman I, Becker D, Wentworth JM, Moran A, Gitelman S, Redondo MJ, Type 1 Diabetes TrialNet Study Group

Abstract
Background: Given the global rise in both type 1 diabetes incidence and obesity, the role of BMI on type 1 diabetes pathophysiology has gained great interest. Sustained excess BMI in pediatric participants of the TrialNet Pathway to Prevention cohort (PTP) increased risk of progression to type 1 diabetes, but the effects of age and obesity in adults remain largely unknown.
Objective: To determine the effect of age and sustained obesity on the risk of type 1 diabetes in adult participants in the TrialNet PTP cohort, i.e. non-diabetic autoantibody-positive relatives of patients with type 1 diabetes.
Research Design and Methods: Longitudinally accumulated BMI above 25kg/m2 was calculated to generate a cumulative excess BMI (ceBMI) for each subject, with ceBMI values >0 kg/m2 and >5kg/m2 representing sustained overweight or obese status, respectively. Recursive partitioning analysis yielded sex- and age-specific thresholds for ceBMI that confer the greatest risk for type 1 diabetes progression.
Results: In this cohort of 665 adults (age 20-50 years, median follow-up 3.9 years), 49 participants developed type 1 diabetes. Age was an independent protective factor for type 1 diabetes progression (HR=0.95, p=0.008), with a threshold of >35 years that reduced risk of type 1 diabetes. In men >35 years and women <35 years, sustained obesity (ceBMI >5kg/m2) increased risk for type 1 diabetes.
Conclusions: Age is an important factor for type 1 diabetes progression in adults and influences the impact of elevated BMI, indicating an interplay of excess weight, age, and sex in adult type 1 diabetes pathophysiology.

PMID: 29092051 [PubMed - as supplied by publisher]

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