Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy.
UOD Diabetes Center, ASST Cremona, 26100 Cremona, Italy.
J Clin Endocrinol Metab. 2023 Oct 18;108(11):e1224-e1235. doi: 10.1210/clinem/dgad302.
Obesity is a growing emergency in type 1 diabetes (T1D). Sex differences in obesity prevalence and its clinical consequences in adult T1D subjects have been poorly investigated. The aim of this study was to investigate the prevalence of obesity and severe obesity, clinical correlates, and potential sex differences in a large cohort of T1D subjects participating to the AMD (Associazione Medici Diabetologi) Annals Initiative in Italy.
The prevalence of obesity [body mass index(BMI) ≥30 kg/m2] and severe obesity (BMI ≥ 35 kg/m2) according to sex and age, as well as obesity-associated clinical variables, long-term diabetes complications, pharmacological treatment, process indicators and outcomes, and overall quality of care (Q-score) were evaluated in 37 436 T1D subjects (45.3% women) attending 282 Italian diabetes clinics during 2019.
Overall, the prevalence of obesity was similar in the 2 sexes (13.0% in men and 13.9% in women; mean age 50 years), and it increased with age, affecting 1 out of 6 subjects ages >65 years. Only severe obesity (BMI >35 kg/m2) was more prevalent among women, who showed a 45% higher risk of severe obesity, compared with men at multivariate analysis. Cardiovascular disease risk factors (lipid profile, glucose, and blood pressure control), and the overall quality of diabetes care were worse in obese subjects, with no major sex-related differences. Also, micro- and macrovascular complications were more frequent among obese than nonobese T1D men and women.
Obesity is a frequent finding in T1D adult subjects, and it is associated with a higher burden of cardiovascular disease risk factors, micro- and macrovascular complications, and a lower quality of care, with no major sex differences. T1D women are at higher risk of severe obesity.
肥胖是 1 型糖尿病（T1D）日益严重的问题。在成年 T1D 患者中，肥胖的流行率及其临床后果存在性别差异，但这方面的研究很少。本研究旨在调查意大利 AMD（意大利糖尿病医生协会）年报计划中参与的大量 T1D 患者中肥胖和重度肥胖的流行率、临床相关性以及潜在的性别差异。
根据性别和年龄评估了 37436 名 T1D 患者（45.3%为女性）的肥胖患病率[体重指数（BMI）≥30kg/m2]和重度肥胖患病率（BMI≥35kg/m2），以及肥胖相关的临床变量、长期糖尿病并发症、药物治疗、过程指标和结果以及整体护理质量（Q 评分）。这些患者于 2019 年在 282 家意大利糖尿病诊所就诊。
总体而言，两性肥胖的患病率相似（男性为 13.0%，女性为 13.9%；平均年龄为 50 岁），且随年龄增长而增加，65 岁以上患者中每 6 人就有 1 人肥胖。仅重度肥胖（BMI>35kg/m2）在女性中更为常见，多因素分析显示女性发生重度肥胖的风险比男性高 45%。肥胖患者的心血管疾病危险因素（血脂谱、血糖和血压控制）和糖尿病整体护理质量较差，但性别间无明显差异。此外，肥胖的 T1D 男性和女性比非肥胖患者更易发生微血管和大血管并发症。
肥胖是 T1D 成年患者的常见现象，与更高的心血管疾病危险因素负担、微血管和大血管并发症以及护理质量降低相关，性别间无明显差异。T1D 女性发生重度肥胖的风险更高。
