The Role of Age and Excess Body Mass Index in Progression to Type 1 Diabetes in At-Risk Adults
Open accessAbstract
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.
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In people with established type 1 diabetes, presence of obesity can worsen insulin resistance, glycemic variability, microvascular disease complications, and cardiovascular risk factors.
“in people with established type 1 diabetes, presence of obesity can worsen insulin resistance, glycemic variability, microvascular disease complications, and cardiovascular risk factors (184 -188).”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [184]
The Conclusions (page unavailable) suggest that overweight or obesity may cause insulin resistance, but the study concerns autoantibody-positive adults before clinical type 1 diabetes, not people with established disease. The cited paper does not support the attributed claims about glycemic variability, microvascular complications, or cardiovascular risk factors in people with established type 1 diabetes. (LLM, conf=0.83)
Experimental — accuracy not yet measuredA recent study suggested obesity may promote progression to overt type 1 diabetes in at-risk individuals, but further confirmatory studies are needed.
“A recent study suggested obesity may promote progression to overt type 1 diabetes in at-risk individuals (183), but further con fi rmatory studies are needed.”
From Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (2019) · cites this paper as [183]
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- Authors
- Ferrara, C. T., Geyer, S. M., Evans-Molina, C., Libman, I. M., Becker, D. J., Wentworth, J. M., Moran, A., Gitelman, S. E., Redondo, M. J., & Type 1 Diabetes TrialNet Study Group
- Affiliations
- University of California, San Francisco (US)
- University of South Florida (US)
- Department of Medicine, Indiana University School of Medicine
- Children's Hospital of Pittsburgh (US)
- The Royal Melbourne Hospital (AU)
- University of Minnesota (US)
- Texas Children's Hospital (US)
- Corresponding author
- Ferrara, Christine T
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2017-10-06
- Volume
- 102
- Issue
- 12
- Pages
- 4596-4603
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC5718698
- OpenAlex
- W2767148243
- Cited by
- 33
- References
- 38
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 4 · 2023: 3 · 2022: 5 · 2021: 3 · 2020: 2 · 2019: 4 · 2018: 3
- FWCI
- 1.63
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- PMC
- Funders
- National Institutes of Health (K12-DK-094726, U01-DK-103180-01)
- National Institute of Diabetes and Digestive and Kidney Diseases
- National Institute of Allergy and Infectious Diseases
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (U01 DK061010, U01 DK061034, U01 DK061042, U01 DK061058, U01 DK085465, U01 DK085453, U01 DK085461, U01 DK085463, U01 DK085466, U01 DK085499, U01 DK085504, U01 DK085505, U01 DK085509, U01 DK103180, U01-DK103153, U01-DK085476, U01-DK103266)
- Juvenile Diabetes Research Foundation International
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 1 diabetes, disease progression, body mass index, obesity, age, sex differences
- MeSH terms
- Adult, Aging, Algorithms, Autoantibodies, Diabetes Mellitus, Type 1, Female, Humans, Insulin Antibodies, Longitudinal Studies, Male, Middle Aged, Obesity, Risk Factors, Sex Characteristics, Socioeconomic Factors, Cohort Studies, Body Mass Index, Disease Progression, Overweight, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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