Relationship between body adiposity and glycemic control in children and adolescents with type 1 diabetes

Aims: To investigate the relationship between body adiposity and glycemic control in children and adolescents with type 1 diabetes (T1D). Methods: This cross-sectional study included 364 children and adolescents aged 6-18 years with T1D. Anthropometric indices [BMI, BMI Z-score, waist-to-height ratio (WHtR)] and body composition [fat mass (FM), FM%, fat mass index (FMI)], assessed using bioelectrical impedance analysis, were obtained. Hemoglobin A1c and glucose sensor metrics, including time in range (TIR), were used to assess glycemic control. Associations between variables were analyzed using Spearman's correlation. Logistic regression models were run to identify independent predictors of HbA1c < 7.0% and TIR > 70%, with FMI, WHtR, total daily insulin dose per kg (TDD), treatment modalities, sex, age, diabetes duration, and pubertal stage as independent variables. Results: Adiposity measures (FMI, FM%, and WHtR) were positively associated with HbA1c and negatively with TIR in both sexes. Logistic regression showed that HbA1c < 7% and TIR > 70% were significantly predicted by FMI [OR(95%CI): 0.822(0.704-0.960), p = 0.013, and 0.807(0.681-0.955), p = 0.012, respectively] and WHtR(x100) [OR(95%CI): 0.927(0.874-0.983), p = 0.013, and 0.923(0.866-0.985), p = 0.015, respectively], independently of TDD, sex, treatment modalities and the other independent variables. Conclusions: Body adiposity negatively impacts glycemic control in children and adolescents with T1D, independent of sex and insulin treatment modalities. Despite technological advances in diabetes care, excess adiposity is emerging as a key modifiable factor associated with poorer glycemic outcomes and, consequently, poorer long-term health in children and adolescents with T1D.