(DCP056) OVERWEIGHT AND OBESITY IN PEOPLE LIVING WITH TYPE 1 DIABETES: A CROSS-SECTIONAL ANALYSIS OF THE BETTER REGISTRY

Background: Historically, people living with type 1 diabetes (PwDT1) had a normal or low body mass index (BMI). Parallel to the increasing prevalence of overweight (OW) and obesity (OB) in the general population, a similar phenomenon has also been observed in PwT1D in recent years. However, the emergence of OW and OB in PwT1D has not been well documented in terms of clinical impact. Thus, the objectives of this study were to assess in adult PwT1D: i) frequency and characteristics of OW and OB; ii) frequency of insulin resistance and double diabetes; and iii) the use of off-label insulin adjuvant therapies.

METHODS AND RESULTS: A cross-sectional analysis of the BETTER registry based on patient-reported outcomes of adult PwT1D (N=1091) classified into three BMI classes: underweight + normal (UNW), < 25; OW, 25-29; OB, ≥30 kg/m2. Uni- and bivariate analyses searched for associations between BMI classes, PWT1D characteristics, and parameters related to type 1 diabetes, including glycated hemoglobin (A1c), estimated insulin resistance (IR), double diabetes (DD), treatments, off-label insulin adjuvants, micro and macrovascular complications. Multivariate analysis and backward stepwise regression evaluated associated OW+OB risk factors.
The presence of overweight and obesity was high, with 34.6% of participants in the OW class and 19.8% in the OB class. When looking at DD, 64% of OW participants and 99% of OB participants presented DD. OW/OB classes were associated with male sex, older age, being born in Canada, lower education level, longer duration of diabetes, higher long-acting insulin doses and IR (p < 0.001 for all). The OW and OB groups were also associated with more prescriptions for high blood pressure, dyslipidemia, and depression (p < 0.001). The OB class reported higher A1c (p < 0.05), less frequent level-1 hypoglycemia (p < 0.05), more retinopathy and neuropathy, as well as having more metformin and/or glucagon-like peptide-1 (GLP-1) analog prescriptions (p < 0.001) than the other two BMI classes. Multiple analysis and backward stepwise regression confirmed that the OW and OB classes combined were more likely to be of male sex, be older, have higher daily basal insulin dose, and take hypertension/nephroprotection medication.

Conclusion: In adult PwT1D, overweight and obesity are highly frequent and are associated with more frequent micro and macrovascular complications and 0ff-label insulin adjuvant prescription.