PSUN92 Type 1 Diabetes and Obesity: The Overlooked Epidemic

Abstract

Abstract Introduction The type 1 diabetes (T1D) cohort in the DCCT study (1983-1989) began with a 1.3% prevalence of obesity that climbed to 18.6% with intensive insulin therapy, and subsequently increased further to a prevalence of 31% in the EDIC observational study (2005).1, 2 The aim of this report was determine the prevalence of overweight and obesity in T1D patients seen at our institution. Methods The electronic health record system was used to create a cross-sectional summary of patients with T1D seen on or before the index date (8/12/2021). Patients were included if they were ≥18 years of age, with at least two outpatient encounters with primary care provider or endocrinologist within the past 18 months, along with an active diagnosis of T1D (ICD-9 or -10 code) on their problem list, or at least 2 encounter diagnosis for T1D in the past 18 months, or documentation of a positive glutamic acid decarboxylase (GAD)-65 antibody titer. Categorical and continuous variables were summarized using N (%) and median (IQR), respectively. Results A total of 2,165 patients were identified. The population was 51% female and 86% Caucasian, with median age of 44 years (33, 55). The median A1C (%) was 7.9% (6.9, 9.4), median income $63,381 ($49,611, $78,367), and insurance coverage was 50% commercial, 11% Medicaid, 23% Medicare, and 16% other. While the median BMI (kg/m2) was 26.7 (23.6, 30.5), the % with a BMI 25-29.9 or ≥30 were 37% and 28%, respectively. Conclusion There is a high prevalence of overweight and obesity in patients with T1D. While the prevalence of these comorbidities is less than what is observed in the general population, 31.1 and 42.4%, respectively (2017–2018)3, it signifies that the T1D population still has a heavy burden of these comorbidities that is contradictive to the stereotype T1D patients are lean. These results stand in stark comparison with the starting 1.3% prevalence of obesity in the DCCT study. Studies directed at the burden of overweight and obesity in T1D patients are necessary to optimize the treatment and prevention of these comorbidities. Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14): 977–986. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, Raskin P, Zinman B; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005 Dec 22;353(25): 2643-53. doi: 10.1056/NEJMoa052187. PMID: 16371630; PMCID: PMC2637991. Centers for Disease Control and Prevention. Obesity and Overweight. https://www.cdc.gov/nchs/fastats/obesity-overweight.htm. Last visited 1/12/2022. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.