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© 2005 by the American Diabetes Association, Inc.
Pathophysiology/Complications |
Impact of Overweight on Chronic Microvascular Complications in Type 1 Diabetic Patients
From the Department of Diabetology, Metabolism and Nutrition, University Hospital of Antwerp, Antwerp, Belgium
Address correspondence and reprint requests to Christophe De Block, MD, PhD, Department of Diabetology, Faculty of Medicine, University Hospital Antwerp, Wilrijkstraat 10, B-2650 Edegem, Belgium. E-mail: christophe.deblock{at}ua.ac.be
OBJECTIVE—To investigate a possible association of BMI with retinopathy and neuropathy in type 1 diabetes. Retinopathy and neuropathy may not only be related to glycemic control and diabetes duration but also to blood pressure and BMI.
RESEARCH DESIGN AND METHODS—A total of 592 type 1 diabetic patients without nephropathy were studied (M/F: 324/268; age: 41 ± 12 years; duration: 19 ± 11 years; HbA1c [A1C]: 7.9 ± 1.1%). Patients were subdivided according to BMI: 168 men and 146 women with BMI <25 kg/m2, and 156 men and 122 women with BMI 
25 kg/m2. Retinopathy was examined by fundoscopy and neuropathy by electromyography.
RESULTS—Hypertension (>130/85 mmHg) was present in 40%, retinopathy in 53%, and neuropathy in 43% of patients. Overweight subjects had more retinopathy (63 vs. 45%, P < 0.0001, odds ratio [OR] = 2.1) and neuropathy (49 vs. 38%, P = 0.008, OR = 1.6) than normal-weight patients. Patients with retinopathy were older (45 ± 12 vs. 37 ± 11 years, P < 0.0001) and had a longer diabetes duration (25 ± 10 vs. 12 ± 8 years, P < 0.0001), a higher A1C (8.0 ± 1.1 vs. 7.7 ± 1.1%, P = 0.001), and a higher BMI (25.8 ± 4.1 vs. 24.7 ± 4.2 kg/m2, P = 0.001) than individuals without retinopathy. The same results are found in neuropathy. Logistic regression analysis showed that diabetes duration (ß = 0.15, P < 0.0001), blood pressure (ß = 0.22, P = 0.0047), and A1C (ß = 0.24, P = 0.01), but not BMI, lipid levels, sex, or age, were independent risk factors for retinopathy. Likewise, duration (ß = 0.05, P < 0.0001), age (ß = 0.04, P = 0.0001), A1C (ß = 0.35, P < 0.0001), and sex (ß = 0.74, P = 0.0001) but not BMI, lipid levels, or hypertension were independently associated with neuropathy. Men had more neuropathy than women (50 vs. 34%, P < 0.0001, OR = 1.9). Leptin and adiponectin levels did not differ between individuals with or without microvascular complications.
CONCLUSIONS—Retinopathy and neuropathy are more prevalent in overweight (BMI 25 kg/m2) type 1 diabetic subjects. However, logistic regression analysis showed that diabetes duration and A1C remain the main determinants for retinopathy and neuropathy.
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