Obesity and overweight-related differences in cardiometabolic risk factors in type 1 diabetes

Assess the prevalence of overweight and obesity and the association between weight and cardiometabolic risk factors among veterans with type 1 diabetes (T1D).

Persons with T1D, between the ages of 21 and 75 years, were identified from Veterans Health Administration administrative databases. Prevalence of weight categories was determined using data between 2022 and 2023, while longitudinal trends were examined in 2-year intervals from 2016-2017 to 2022-2023. Differences in prevalence were adjusted for baseline characteristics and differences in cardiometabolic risk factors were adjusted for age, sex and race/ethnicity.

Nine thousand seven hundred twelve T1D veterans met inclusion criteria. Prevalence of overweight and obesity in 2022-2023 was 39.7% and 32.4%, respectively, and differed by race/ethnicity. Prevalence rates have risen steadily since 2016, most notably in those ages 21-39. Compared to normal weight veterans, overweight and obese veterans were older (p = 0.003), more frequently male (p = 0.024), and were more likely to be on anti-obesity (p < 0.001) and other cardioprotective medicines. Levels of cardiometabolic risk factors (blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, and estimated glomerular filtration rate) were worse at higher weight categories (all p < 0.001) and appeared linearly related to body mass index (BMI). Several risk factors demonstrated age-BMI interactions, with younger veterans demonstrating greater changes in these risk factors with rising BMI.

There is a high and rising prevalence of obesity among adult veterans with T1D, and a strong association of obesity with adverse cardiometabolic risk factors remains even in T1D. These trends highlight the need for a better understanding of mechanisms of weight gain in T1D and improved weight management strategies.