Overweight and obesity in patients with type 1 diabetes: associations with vascular complications and biomarkers of vascular remodeling

BACKGROUND: The prevalence of overweight and obesity in patients with type 1 diabetes (T1D) is increasing, which raises the issue of their impact on the development of complications.

AIM: to study the associations of overweight and obesity with vascular complications, cardiovascular risk factors and serum levels of vascular remodeling biomarkers in patients with T1D.

MATERIALS AND METHODS: The study included 547 patients, including 309 with body mass index (BMI) <25 kg/m², 155 with BMI 25–29.9 kg/m², and 83 with BMI ≥30 kg/m². Insulin sensitivity was assessed by the estimated glucose disposal rate. In the serum of 130 patients and 30 individuals with normal weight and normal glucose tolerance, concentrations of advanced glycation end products (AGEs), endothelin-1, endothelial NO synthase (NOS3), adrenomedullin (ADM), endothelial cell-specific molecule-1 (ESM1), cell adhesion molecules (ICAM-1 and VCAM-1), integrin-associated protein-1 (IAP-1), integrin receptor subunit (ITGB1), heme oxygenase-1 (HO-1), GAS6, decorin, and transforming growth factor β1 (TGF-β1) were determined by ELISA.

RESULTS: Obesity in patients with T1D was independently associated with coronary artery disease, myocardial infarction, and chronic heart failure. Overweight was an independent predictor of chronic heart failure only. Patients with BMI ≥25 kg/m², when compared with those with BMI <25 kg/m², were older, had a reduced insulin sensitivity and increased levels of triglycerides, LDL-cholesterol, uric acid, and high-sensitivity C-reactive protein. Patients with T1D, as compared with controls, showed a significant increase in serum AGEs, endothelin-1, ICAM-1, VCAM-1, IAP-1, ESM1, HO-1, GAS6, and TGF-β1. Overweight patients, when compared with those with BMI <25 kg/m², demonstrated higher levels of ICAM-1, IAP-1, ITGB1 and TGF-β1, while obese individuals had increased concentrations of AGEs, IAP-1 and HO-1.

CONCLUSION: In patients with T1D, overweight and obesity are associated with vascular complications, their risk factors and biomarkers of vascular remodeling.

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