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J Clin Endocrinol Metab. 2017 Dec 1;102(12):4596-4603. doi: 10.1210/jc.2017-01490.

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

Author information

1
Department of Pediatric Endocrinology, University of California at San Francisco94143.
2
Department of Informatics and Biostatistics, University of Southern Florida.
3
Department of Medicine, Indiana University School of Medicine.
4
Department of Pediatric Endocrinology, Children's Hospital of Pittsburgh of UPMC.
5
Department of Medicine, Royal Melbourne Hospital, Australia.
6
Department of Pediatric Endocrinology, University of Minnesota.
7
Section of Pediatric Endocrinology, Texas Children's Hospital.

Abstract

Background:

Given the global rise in both type 1 diabetes incidence and obesity, the role of body mass index (BMI) on type 1 diabetes pathophysiology has gained great interest. Sustained excess BMI in pediatric participants of the TrialNet Pathway to Prevention (PTP) cohort increased risk for 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 for type 1 diabetes in adult participants in the TrialNet PTP cohort (i.e., nondiabetic autoantibody-positive relatives of patients with type 1 diabetes).

Research Design and Methods:

Longitudinally accumulated BMI >25 kg/m2 was calculated to generate a cumulative excess BMI (ceBMI) for each participant, with ceBMI values ≥0 kg/m2 and ≥5 kg/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 to 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 (hazard ratio, 0.95; P = 0.008), with a threshold of >35 years that reduced risk for type 1 diabetes. In men age >35 years and women age <35 years, sustained obesity (ceBMI ≥5 kg/m2) increased the 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.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00097292.

PMID:
29092051
PMCID:
PMC5718698
DOI:
10.1210/jc.2017-01490
[Indexed for MEDLINE]
Free PMC Article

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