The burden of obesity in type 1 diabetic subjects: a sex-specific analysis from the AMD Annals Initiative

Objective: Obesity is a growing emergency also in type 1 diabetes (T1D). Sex-differences in obesity prevalence and its clinical consequences in adult T1D subjects have been poorly investigated. The aim of this study was to investigate the prevalence of obesity and severe obesity, clinical correlates and potential sex-differences in a large cohort of T1D subjects, participating to the AMD Annals Initiative in Italy. Research design and methods: The prevalence of obesity (BMI ≥30 kg/m2) and severe obesity (BMI ≥ 35 kg/m2) according to sex and age, as well as obesity-associated clinical variables, long-term diabetes complications, pharmacological treatment, process indicators and outcomes, and overall quality of care (score Q) were evaluated in 37,436 T1D subjects (45.3% women) attending 282 Italian diabetes clinics during 2019. Results: Overall, the prevalence of obesity was similar in the two gender (13.0% in men and 13.9% in women; mean age 50 years), and it increased with age, affecting 1 out of 6 subjects aged >65 years. Only severe obesity (BMI >35 Kg/m2) was more prevalent among women, who showed a 45% higher risk of severe obesity, compared with men at multivariate analysis.CVD risk factors (lipid profile, glucose and blood pressure control), and the overall quality of diabetes care were worse in obese subjects, with no major sex-related differences. Also, micro- and macrovascular complications were more frequent among obese than non-obese T1D men and women. Conclusions: Obesity is a frequent finding in T1D adult subjects, and it is associated with a higher burden of CVD risk factors, micro- and macrovascular complications, and a lower quality of care, with no major sex-differences. T1D women are at higher risk of severe obesity.