Impact of Overweight on Chronic Microvascular Complications in Type 1 Diabetic Patients

Abstract

OBJECTIVE -To investigate a possible association of BMI with retinopathy and neuropathy in type 1 diabetes. Retinopathy and neuropathy may not only be related to glycemic control and diabetes duration but also to blood pressure and BMI.RESEARCH DESIGN AND METHODS -A total of 592 type 1 diabetic patients without nephropathy were studied (M/F: 324/268; age: 41 Ϯ 12 years; duration: 19 Ϯ 11 years; HbA 1c [A1C]: 7.9 Ϯ 1.1%). Patients were subdivided according to BMI: 168 men and 146 women with BMI Ͻ25 kg/m 2 , and 156 men and 122 women with BMI Ն25 kg/m 2 . Retinopathy was examined by fundoscopy and neuropathy by electromyography.RESULTS -Hypertension (Ͼ130/85 mmHg) was present in 40%, retinopathy in 53%, and neuropathy in 43% of patients. Overweight subjects had more retinopathy (63 vs. 45%, P Ͻ 0.0001, odds ratio [OR] ϭ 2.1) and neuropathy (49 vs. 38%, P ϭ 0.008, OR ϭ 1.6) than normal-weight patients. Patients with retinopathy were older (45 Ϯ 12 vs. 37 Ϯ 11 years, P Ͻ 0.0001) and had a longer diabetes duration (25 Ϯ 10 vs. 12 Ϯ 8 years, P Ͻ 0.0001), a higher A1C (8.0 Ϯ 1.1 vs. 7.7 Ϯ 1.1%, P ϭ 0.001), and a higher BMI (25.8 Ϯ 4.1 vs. 24.7 Ϯ 4.2 kg/m 2 , P ϭ 0.001) than individuals without retinopathy. The same results are found in neuropathy. Logistic regression analysis showed that diabetes duration (␤ ϭ 0.15, P Ͻ 0.0001), blood pressure (␤ ϭ 0.22, P ϭ 0.0047), and A1C (␤ ϭ 0.24, P ϭ 0.01), but not BMI, lipid levels, sex, or age, were independent risk factors for retinopathy. Likewise, duration (␤ ϭ 0.05, P Ͻ 0.0001), age (␤ ϭ 0.04, P ϭ 0.0001), A1C (␤ ϭ 0.35, P Ͻ 0.0001), and sex (␤ ϭ 0.74, P ϭ 0.0001) but not BMI, lipid levels, or hypertension were independently associated with neuropathy. Men had more neuropathy than women (50 vs. 34%, P Ͻ 0.0001, OR ϭ 1.9). Leptin and adiponectin levels did not differ between individuals with or without microvascular complications.CONCLUSIONS -Retinopathy and neuropathy are more prevalent in overweight (BMI Ն25 kg/m 2 ) type 1 diabetic subjects. However, logistic regression analysis showed that diabetes duration and A1C remain the main determinants for retinopathy and neuropathy. Diabetes Care 28:1649 -1655, 2005O verweight (BMI Ն25 kg/m 2 ) and obesity (BMI Ն30 kg/m 2 ) are becoming increasingly prevalent in the industrialized world (1), not only in type 2 but also in type 1 diabetic patients (2-4). Besides physical inactivity, intensive insulin therapy to obtain good metabolic control to reduce complications is associated with weight gain (4,5). The relationship between metabolic control and the development of chronic complications (retinopathy, neuropathy, and nephropathy) is a primary concern of clinicians. Factors involved in the development of vascular complications of diabetes include long diabetes duration, poor glycemic control, smoking, hypertension, and dyslipidemia, but the role of body weight/BMI is unclear.Retinopathy may not only be related to glycemic control and diabetes duration but also to blood pressure and BMI for patients with type 2 diabetes, as was sho...

Overview of the relationship between pain and obesity: What do we know? Where do we go next?

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“…However, studies that have investigated the contributions of the individual components have revealed mixed results 15, 16, 17, 18, 19, 20, 21. We have recently shown that diabetes, prediabetes, and obesity are the main metabolic components associated with peripheral neuropathy in a United States obese population 22.…”

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