New research indicates that restoring body mass index to normal levels may slow the progression from preclinical to clinical type 1 diabetes, especially among children and adolescents, highlighting potential preventive strategies.
Normalising body mass index was linked to a lower risk of progressing to clinical type 1 diabetes in a new analysis of people with diabetes-related autoantibodies and overweight or obesity, according to research published in Diabetes Care. The findings, based on TrialNet Pathway to Prevention data, suggest that the shift into the normal BMI range may be associated with slower movement from preclinical disease to stage 3, when diabetes becomes clinically apparent.
The study examined 833 participants, most of them young people, who already had islet autoantibodies and preclinical type 1 diabetes at baseline. TrialNet’s Pathway to Prevention programme screens relatives of people with type 1 diabetes and follows those who test positive for autoantibodies, allowing researchers to track how the condition develops over time. Over a median 4.1 years of follow-up, BMI returned to the normal range in 26.8% of participants.
Participants whose BMI normalised were younger on average and entered the study with lower BMI z scores than those whose weight remained elevated, and they also showed a different stage distribution at baseline. The cumulative incidence of stage 3 type 1 diabetes was significantly lower in the group whose BMI fell into the normal range, and the association remained after adjustment for age, BMI z score and disease stage. The same pattern held for progression to stage 2 disease, although the researchers stressed that the work was observational and cannot prove cause and effect.
The effect appeared to vary by age and sex. According to the study, the association with lower stage 3 risk was clear in participants younger than 18 but not in adults, and the strongest signals in children and adolescents differed between boys and girls. In exploratory analysis, adjusting for insulin sensitivity and insulin resistance weakened the link, while accounting for insulin secretion and C-peptide strengthened it, pointing to possible biological mechanisms that warrant further study. TrialNet has previously been central to prevention work in type 1 diabetes, including research that helped lead to the first drug approved to delay the disease, teplizumab.
The researchers now want to test whether an intervention that helps normalise BMI can also reduce progression risk in a prospective trial. For now, they are exploring whether insulin resistance, obesity-related inflammation or beta-cell stress explains the association. The authors say the results should be viewed as a promising signal rather than proof that weight reduction alone can prevent type 1 diabetes.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
