Résumé
Introduction and Objectives: Individuals with type 1 diabetes (T1D) are faced with a growing prevalence of obesity, a recognized determinant of cardiovascular (CV) risk. This study aims to evaluate the metabolic profile, CV risk, and diabetes-related complications across body mass index (BMI) classes in individuals with T1D. Methods: Using data from SFDT1, a multicentric French cohort, individuals with T1D were stratified into four BMI classes: underweight (<18.5 kg/m²), normal weight (18.5-24.9 kg/m²), overweight (OW) (25-29.9 kg/m²), and obesity (OB) (BMI ≥30 kg/m²). Baseline statistical analyses were performed with mean ± SD or frequency (%), with group comparisons through Kruskall-Wallis, variance analysis, and Chi-squared tests. Spearman correlation and logistic regression were applied. CV risk was evaluated using the Steno T1 Risk Engine score (STRS) in people in primary prevention. Results: Among 1,724 participants (age 38 years, diabetes duration 22 years, BMI 24.9kg/m2, Male 53%), 8% had a CV history and 31% were classified as OW or OB. Age and duration of diabetes (ranging from 17.5 to 25.0 years) increased with BMI class. The mean HbA1c remained comparable (7.5% overall, p=0.5975) but the proportion of participants with HbA1c≥6.9%, as well as those with high blood pressure and dyslipidemia increased with BMI class. BMI was associated with CV history (OR=1.044, CI95% 1.004-1.084), even after adjustments for age, sex, and diabetes duration. In the primary prevention population, compared to normal weight, those with OW and OB had an increase of STRS at 5 years (57% and 74%) and 10 years (50 and 60%) (p<0.001). BMI correlated with 5 and 10-year STRS (p<0.001) and Waist/Height ratio with 10-year risk (p<0.001). OW and OB were associated with retinopathy but not nephropathy. Conclusion: T1D individuals with OW and OB had more CV history, higher STRS at 5 and 10 years, and more retinopathy. Visceral adiposity was associated with increased STRS.