Type 1 diabetes risk increases with BMI during adolescence



Sugar I, et al. 1263-P. Presented at: American Diabetes Association Scientific Sessions; June 3-7, 2022; New Orleans (hybrid meeting).

Disclosures: Twig reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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NEW ORLEANS — Adolescents’ risk for developing type 1 diabetes rose with increasing BMI, according to data presented at the American Diabetes Association Scientific Sessions and simultaneously published in diabetology.

“There were previous reports on the association between obesity and type 1 diabetes in previous cohorts that included mostly children,” Gilad Twig, MD, PhD, a resident in the department of internal medicine at Sheba Medical Center in Tel Aviv, Israel, told Healio. “We were somewhat surprised to see that the association persisted in adolescents who were perfectly healthy — apart from having abnormal weight — without apparent risk factors for type 1 diabetes.”

overweight child
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Twig and colleagues conducted a retrospective cohort study of adolescents aged 16 to 19 years who underwent a medical examination prior to military conscription in Israel from January 1996 to December 2016. Data from participants were linked to the Israeli National Diabetes registry. BMI was calculated using height and weight measured at baseline. Participants were placed into age- and sex-matched percentiles based on criteria from the CDC. Participants in the 85th to 94th percentile of BMI were considered to have overweight, and obesity was defined as the 95th percentile or higher.

There were 834,050 men and 592,312 women included in the study. Over a median follow-up of 11.2 years, there were 777 incident type 1 diabetes cases during 15,819,750 person-years, for an incidence rate of 4.9 cases per 100,000 person-years.

The risk for type 1 diabetes gradually increased with higher BMI. In multivariable analysis, adolescents in the 75th to 84th percentile of BMI (adjusted HR = 1.41; 95% CI, 1.11-1.78), with overweight (aHR = 1.54; 95% CI, 1.23-1.94) and with obesity (aHR = 2.05 ; 95% CI, 1.58-2.66), had an increased risk for type 1 diabetes compared with those in the fifth to 49th percentile of BMI.

“For adolescents with obesity, the risk for type 1 diabetes was approximately doubled,” Twig said. “It is important to remember that in our study, we grouped all those with obesity in the group regardless of obesity severity. Therefore, it is likely that for adolescents with more severe forms of obesity, the actual risk for developing type 1 diabetes is even higher.”

Each 5-unit increase in BMI was associated with a 35% increase in risk for developing type 1 diabetes (aHR = 1.35; 95% CI, 1.24-1.47) and each 1 standard deviation increase in BMI increased the risk for developing type 1 diabetes by 25% (aHR = 1.25; 95% CI, 1.17-1.32).

Twig said future research is planned to identify more risk factors for incident type 1 diabetes in the same cohort.

“We are, in particular, planning to better identify the characteristics of adolescents in whom excessive weight may have a more emphasized role in the development of type 1 diabetes,” Twig said.


  • Sugar I, et al. diabetology. 2022;doi:10.1007/s00125-022-05722-5.

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