P-175: Weight-glycemia dissociation in youth with type 1 diabetes: real-world metabolic phenotypes
M A Ramos Albuquerque, A Liberal de Matos, J Alencar Melo, A B Barbosa, G Vasconcelos Barros, J Araujo, T Andrade Schuler, B Gomes, P Padilha Ribeiro, A H Ferreira, C Donaire SouzaAbstract
Introduction
Insulin deficiency is classically associated with catabolism and weight loss, leading to reduced BMI during poor metabolic control. Conversely, intensive insulin therapy may promote weight gain due to its anabolic effects. However, with the rising prevalence of overweight, obesity, and insulin resistance in type 1 diabetes (T1D), emerging phenotypes suggest that weight gain may also contribute to glycemic deterioration.
Objectives
To evaluate BMI and HbA1c trajectories over 3 years in youth with T1D.
Methods
This retrospective cohort included 100 individuals aged 0-18 years followed at a public tertiary center in Northeast Brazil who attended clinic over a 3-month period (January-April 2026). Mean HbA1c over the last 3 years was analyzed. Participants were classified into four phenotypes: poor control with BMI increase, poor control with BMI decrease, good control with BMI increase, and good control with BMI decrease. Poor control was defined as HbA1c >7.5%.
Results
Two patients were excluded because of stable BMI (n=98). Mean age was 14.6 years (6.9-18.8), and 51% were female. Most participants had poor glycemic control (92.8%, n=91); among these, 54.9% showed BMI reduction and 45.1% BMI increase. Insulin analogs were used by 93.8% (n=92), and all patients with good control were on analog therapy. Phenotypes A-D included 41, 50, 3, and 4 patients, respectively. Mean HbA1c was 9.8%, 9.7%, 7.4%, and 7.1%, while mean BMI z-score was 0.18, 0.42, 0.06, and -0.12, and mean ΔBMI was +0.45, -0.33, +0.52, and -0.42.
Conclusions
Weight-glycemia dissociation was common in this cohort. A substantial proportion of patients with poor glycemic control gained weight, supporting coexistence of insulin resistance and challenging the classic paradigm of catabolic decompensated T1D. These findings support individualized strategies targeting both glycemia and weight.