DiaComp Funded Abstracts
Program Application Abstract
The Effect of Obesity on Insulin Resistance and Cardiovascular Risk Factors in Type 1 Diabetes
(University of Colorado at Denver and Health Sciences Center)
Summer Student Program
In a cross sectional study of 131 youth (median [p25-75]: 16 [14, 17] years of age, Tanner 5 [4, 5]) with type 1 diabetes (T1D) (6.75 [3.5, 10.3] yrs diabetes duration)—we analyzed the impact of obesity on cardiovascular (CV) health and insulin resistance. We compared this cohort to healthy controls and a cohort with type 2 diabetes (T2D) to assess where on a spectrum T1D patients compare regarding IR. We hypothesized that obesity would worsen CV health and IR. The T1D cohort was broken into three categories based on BMI percentile (lean [n=79], overweight [n=26], and obese [n=26]). The T1D cohort was matched to similar lean control [n=59], obese control [n=54], and T2D cohorts [n=56]. All subjects underwent fasting labs and a hyperinsulinemic euglycemic clamp to evaluate insulin sensitivity (GIR). CV measures included echocardiography, exercise testing, and brachial artery distensibility by Dynapulse. T1D subcohorts were compared by ANOVA. GIR per free fat mass (mg/FFMkg/mL) was significantly lower in the T1D cohorts (19.29 [14.40, 21.30] vs 12.35 [9.44, 14.78] p<0.001). In addition, obesity worsened GIR per FFM in T1D (12.35 [9.44, 14.78] in lean vs 7.74 [5.67, 10.66] in obese, p<0.001). While systolic function did not vary among the T1D groups, diastolic function parameters (mitral valve E/A ratio, septal E:E’, and lateral E:E’) showed significant worsening with obesity. Exercise capacity (VO2 Max) was markedly decreased with obesity in T1D, as was brachial artery distensibility. Overall, obesity paints a negative picture for T1D adolescents. While more research is needed on obesity in T1D, our data merit more clinical consideration on the importance of managing weight in T1D to prevent future CVD.
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