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BMI Normalization Is Associated With Lower Risk of Progression to Type 1 Diabetes, Primarily in Youth
Maria J Redondo1, David Cuthbertson2, Raquel Gupta1
1Baylor College of Medicine, Houston, TX.
Diabetes Care
|July 16, 2026
Summary
Normalizing body mass index (BMI) significantly lowers the risk of developing stage 3 type 1 diabetes (T1D) in at-risk youth. This finding highlights the importance of weight management in preventing clinical T1D progression.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Immunology
Background:
- Elevated body mass index (BMI) is a known risk factor for the progression to stage 3 type 1 diabetes (T1D).
- Autoantibody positivity indicates an increased risk of developing T1D.
Purpose of the Study:
- To investigate the association between BMI normalization and the risk of progression to stage 3 T1D.
- To assess this association in autoantibody-positive individuals with overweight or obesity.
Main Methods:
- A cohort of 833 autoantibody-positive participants with overweight or obesity from the TrialNet Pathway to Prevention study was analyzed.
- Cox proportional hazards models were used to evaluate the cumulative incidence of stage 3 T1D.
- Statistical adjustments were made for baseline age, BMI z score, and T1D stage.
Main Results:
- BMI normalization occurred in 26.8% of participants and was associated with a 48.4% reduced risk of progression to stage 3 T1D (HR 0.516, P < 0.001) over a median follow-up of 4.1 years.
- The protective association was significant in youth (HR 0.497, P = 0.001) but not in adults (P = 0.130).
- BMI normalization also reduced the risk of transitioning from stage 1 to stage 2 (P = 0.003) and stage 2 to stage 3 (P = 0.051).
Conclusions:
- BMI normalization is linked to a substantially lower risk of developing clinical T1D in autoantibody-positive individuals with overweight or obesity.
- The benefit of BMI normalization is most pronounced in the pediatric population.
- Weight management strategies may play a crucial role in preventing T1D progression, particularly in at-risk youth.
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