Overweight and obesity in type 1 diabetes: associations with glycemic control and cardiometabolic risk

Abstract

Aims: This cross-sectional study aimed to investigate associations of body mass index (BMI) and waist circumference (WC) with glycemic control and other cardiometabolic risk factors in patients with type 1 diabetes (T1D). Methods: Patients followed in the Insulin Pump Clinic at a tertiary hospital were selected. Data from clinical records and continuous glucose monitoring (CGM)-derived parameters were retrospectively documented (2022-2024). Associations of BMI and WC with cardiometabolic risk factors were assessed using linear regression models. Restricted cubic splines analyses were performed to assess for nonlinear associations. Results: Of the 388 patients included, 32.3% were overweight and 13.7% obese. Patients with obesity and increased WC had higher systolic (p=0.013 and p=0.038) and diastolic blood pressure (p=0.001 and p=0.015), non-HDL cholesterol (p=0.022 and p=0.010) and triglycerides (p=0.001 and p<0.001) values. A non-linear association between BMI and glycated hemoglobin (HbA1c) was found, with higher HbA1c levels corresponding to the extreme BMI values. A higher time in range (p=0.036) was found in the increased WC group. Conclusions: In patients with T1D, BMI and WC were more strongly associated with blood pressure and lipid profile than with glycemic control. A better understanding of the role of obesity in the cardiometabolic risk of patients with T1D is essential to improve the management of this common comorbidity. Keywords: Obesity, T1D, cardiometabolic risk, glycemic control, CGM.