Endocrinology Network Staff

American Diabetes Association 82nd Scientific Sessions

 could increase risk of type 1 diabetes in young adulthood.

Although typically associated with increased risk of type 2 diabetes, the study leveraged data from more than 1.4 million adolescent patients and found an increased risk of type 1 diabetes among adolescents with overweight and obesity, with a graded increase for type 1 diabetes observed across BMI categories.

“Our findings have public health implications. The prevalence of adolescent obesity is rising worldwide at an alarming rate, with dire projections for the near future,” wrote investigators.

Led by Gilad Twig, MD, PhD, of Tel Aviv University, along with colleagues from other Israel-based institutions and Canada, the study was designed to estimate potential associations between BMI in late adolescence and incident type 1 diabetes in late adulthood. With this in mind, investigators designed their study as a retrospective cohort study using data from a pair of data sources aggregating information from patients in Israel. The first database provided investigators with information on all Israeli adolescents ages 16-19 years, unless they had a history of dysglycemia, who underwent medical valuation in mandatory military conscription from 1996-2016. The second database was the Israeli National Diabetes Registry, which investigators used to assess the incidence of adult-onset type 1 diabetes.

The primary outcome of interest for the investigators’ analysis was the incident of type 1 diabetes, which was defined as use of short-acting insulin that was initiated within 1 year of diabetes onset without the prescription of other antiglycemic properties. For the purpose of analysis, weight and height at age 17 were used in the investigators’ Cox proportional hazards model, which assessed BMI as both a categorical and continuous variable.

Overall, investigators obtained data related to 1,426,362 individuals without type 1 diabetes in adolescence and a total of 777 incident cases of type 1 diabetes during 15,810,751 person-years of follow-up. Investigators pointed out the mean age at diagnosis among these patients was 25.2±3.9 years and initial analysis indicated BMI was associated with incident type 1 diabetes.

In models adjusted for age, sex, and sociodemographic variables, a graded increase in risk was observed across BMI categories. Specifically, the hazard ratios for incident type 1 diabetes were 1.05 (95% CI 0.87-1.27) for the 50th to 74th BMI percentiles, 1.41 (1.11-1.78) for the 75th to 84th BMI percentiles, 1.54 (1.23-1.94) for adolescents with overweight, and 2.05 (95% CI, 1.58-2.66) for adolescents with obesity. Of note, overweight was considered a BMI in the 85th to 94th percentiles and obesity was considered being among the 95th percentile or greater. Further analysis suggests a single standard deviation increase in BMI was associated with a 25% increase in risk of type 1 diabetes (HR, 1.25 [95% CI, 1.17-1.32]).

“Our study adds to the growing evidence regarding the health hazards associated with adolescent obesity. Not only is adolescent obesity correlated with adult-onset of type 2 diabetes as previously reported, but also with type 1 diabetes,” investigators noted. “Further work needs to be done to unravel this association so that we can better address the full spectrum of risks posed by the obesity epidemic or identify common environmental factors affecting both weight and type 1 diabetes.”

Obesity in late adolescence and incident type 1 diabetes in young adulthood

,” was presented at ADA 2022 and published in 

Originally published on our sister brand, 

Articles

New research suggests adolescent obesity could increase risk of type 1 diabetes in young adulthood.

Obesity in adolescence could raise type 1 diabetes risk in adulthood

Despite an emphasis in recent years on improving the uptake of new diabetes technologies, new research presented at the 

Endocrine Society’s annual meeting (ENDO 2022)

 paints a grim picture related to the uptake of insulin pumps in pediatric patients with 

 across different racial and ethnic backgrounds.

An analysis of data from the SEARCH for Diabetes in Youth study, results of the study detail the increase in CGM uptake from 2001-2019, with results providing evidence of significant improvements in terms of overall uptake, but also pointing to a lack of improvements among certain patient groups, including Black patients, those using public insurance, and those with lower household incomes.

"We found there is a huge divide in who actually has access to insulin pumps," said lead investigator Estelle Everett, MD, MHS, of the David Geffen School of Medicine at University of California, 

. “Racial-ethnic minority groups and those of lower socioeconomic status still have unequal access to this very beneficial management tool. This is really concerning because these groups have more challenges managing their diabetes and have higher risk of complications. Changes in the approach to diabetes care and health policies are needed to ensure equal access to this life-changing diabetes device."

Nearly 50 years removed from the invention of the first insulin pump, the conversation has shifted from the potential benefits to eliminating barriers preventing optimized uptake of these devices. As the prevalence of pump use has increased, an understanding of contemporary barriers to insulin pump access stands to have a tangible impact on patient-level care and diabetes management as a whole. With this in mind, Everett and a team of colleagues from institutions across the US conducted the current study with the intent of evaluating how inequities in insulin pump use among pediatric patients with type 1 diabetes may have increased or diminished over time.

To do so, investigators designed their study to leverage data from the SEARCH for Diabetes in Youth study in order to perform a serial cross-sectional analysis to assess changes in insulin pump between 2001-2005, 2006-2010, 2011-2015, and 2016-2019. Patients of interest for the analyses were participants aged 19 years or less with type 1 diabetes. Subgroups of interest for the analysis were defined by racial and ethnic group, health insurance, household income, and formal parental education. For the purpose of analysis, multivariable generalized estimating equations with a binomial distribution were used to assess the probability of insulin pump use, and models were further adjusted for the other predictors, including age, diabetes duration, and clinic site, with clustering for individuals.

Initial analysis demonstrated the overall prevalence of insulin pump use had increased among pediatric patients with type 1 diabetes from 30% in 2001-2005 to 58.3% in 2016-2019. When compared to non-Hispanic White patients, a statistically significant increase in prevalence of pump use among Hispanic patients, with the adjusted odds ratio (OR) increasing from 0.08 (95% CI, 0.01-0.63) in 2001-2006 to 0.65 (95% CI, 0.48-0.87) in 2016-2019 (

=.004). However, the OR for Black patients (

=.439) did not change over the course of the study period.

In additional analyses, results demonstrated those with some high school education (OR, 0.38 [95% CI, 0.30-0.48]; 

) or a high school degree (OR, 0.69 [95% CI, 0.57-0.82]; 

=.894) were less likely to be using an insulin pump when compared to their counterparts with a bachelor’s degree or more and this did not change over time. When compared to their counterparts with private insurance, those with public health insurance were less likely to be using an insulin pump and this did not change over time (OR, 0.84 [95% CI, 0.68-1.03]; 

=.815). Investigators also pointed those with an annual household income below $25,000 (OR, 0.43 [95% CI, 0.34-0.54]; 

=.937), $25,000-$49,000 (OR, 0.57 [95% CI, 0.46-0.71]; 

=.870), and $50,000-$74,999 (OR, 0.80 [95% CI, 0.65-0.97]; 

=.821) were less likely to be using an insulin pump than those with an annual household of $75,000 or more and this did not change over the course of the study period.

“Inequities in access to diabetes technologies are unacceptable because everyone deserves the opportunity to improve their diabetes health," Everett added. "Studies that evaluate barriers and test interventions to improve technology access are needed to address the persistent inequities in diabetes care."

This study, “Assessing Longitudinal Disparities in Insulin Pump Use Among Youth with Type 1 Diabetes,” was presented at ENDO 2022.

An analysis of the SEARCH for Youth in Diabetes details historic and contemporary disparities in insulin pump use for pediatric type 1 diabetes based on racial/ethnic background, household income, and insurance type.

Endocrinology Network Staff

Articles

Obesity in adolescence could raise type 1 diabetes risk in adulthood

In pediatric type 1 diabetes, race, income, insurance remain barriers to insulin pump use