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

the Type 1 Diabetes TrialNet Study Group

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)4596-4603
Number of pages8
JournalJournal of Clinical Endocrinology and Metabolism
Issue number12
StatePublished - Dec 1 2017

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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