A recent study from the TrialNet Pathway to Prevention initiative suggests that restoring body mass index to a normal range may lower the risk of developing clinical type 1 diabetes among young people with islet autoantibodies and overweight or obesity, highlighting potential new avenues for disease delay strategies.
A new analysis from the TrialNet Pathway to Prevention study suggests that normalising body mass index may be linked to a lower risk of progressing to clinical type 1 diabetes in people who already carry islet autoantibodies and have overweight or obesity. In Diabetes Care, researchers reported that participants whose BMI returned to the normal range had a lower adjusted risk of stage 3, or clinical, type 1 diabetes than those whose BMI stayed elevated.
The study looked at 833 autoantibody-positive participants with preclinical type 1 diabetes who were followed for a median of 4.1 years. Most were young people. During that period, BMI fell into the normal range in 26.8% of the group. Those whose BMI normalised were younger on average at the start of the study and had lower BMI z scores, while the distribution of disease stage also differed between the two groups. The authors found that the cumulative incidence of clinical type 1 diabetes was lower among those whose BMI normalised, and the association remained after adjustment for age, baseline BMI and stage of disease.
The signal was strongest in younger participants. The researchers reported a significant association in people under 18, but not in adults. Among children under 12, the association appeared in boys but not girls, while in adolescents it was seen in girls but not boys. When the team looked at progression to stage 2 disease as well, BMI normalisation still tracked with lower risk. Exploratory analyses suggested that insulin resistance, insulin sensitivity and beta cell stress could all be relevant to the biological explanation, although the authors cautioned that the work was observational and cannot prove cause and effect.
TrialNet, launched with National Institutes of Health support in 2000, was designed to identify people at risk of type 1 diabetes and slow disease progression. The new findings add to a growing body of work on prevention, coming after TrialNet’s teplizumab study showed that immunotherapy could delay the onset of clinical disease by a median of 2 years in high-risk individuals. The latest analysis does not establish that weight loss itself prevents type 1 diabetes, but it does raise the possibility that restoring BMI to a healthier range may be part of the risk profile in children and adolescents already on the disease pathway.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
