P-330: Body mass index and progression to clinical type 1 diabetes among autoantibody-positive youth
C Baez-Smith, C Baez-SmithAbstract
Introduction
Higher body mass index (BMI) may increase insulin resistance and beta-cell stress, potentially accelerating progression from islet autoimmunity to clinical T1D. This relationship is important for pediatric diabetes prevention, especially for medically underserved youth with reduced access to early screening and specialty follow-up.
Objectives
To synthesize evidence on BMI/adiposity and progression toward stage 3 T1D in autoantibody-positive children, adolescents, and transition-age youth.
Methods
A PRISMA-informed evidence synthesis was conducted using an EBSCOhost export from CINAHL Complete, MEDLINE with Full Text, Academic Search Complete, Health Source, Alt HealthWatch, and Health and Psychosocial Instruments. Search concepts included T1D, BMI/adiposity, islet autoantibodies or early-stage T1D, progression, and youth. Records were screened by title and abstract for relevance to BMI, islet autoimmunity, clinical T1D progression, and equity variables. Findings were summarized narratively due to heterogeneity in design and outcomes.
Results
The export contained 894 records. Title/abstract mapping identified 28 pediatric or youth-relevant candidate records containing T1D, BMI/adiposity, early-stage or progression, and age-related terms. Direct evidence linking BMI to progression from autoantibody positivity to stage 3 T1D was limited, but available evidence supported the accelerator hypothesis: higher BMI or excess adiposity may intensify metabolic demand and accelerate progression in susceptible youth. Equity variables, including race/ethnicity, socioeconomic status, and screening access, were inconsistently reported.
Conclusions
BMI may be a clinically relevant, modifiable factor in early T1D progression among at-risk youth. Current evidence supports attention to BMI in pediatric T1D risk stratification and highlights a gap in equity-focused research on progression among medically underserved populations.