Improved glycemic control reduces the impact of weight gain on cardiovascular risk factors in type 1 diabetes - The epidemiology of diabetes complications study

OBJECTIVE - To assess the prevalence and incidence of being overweight in t ype 1 diabetes, to identify factors associated with weight gain and improve d glycemic control, and to examine relationships among weight gain, glycemi c control, and cardiovascular risk factors. RESEARCH DESIGN AND METHODS - The prevalence and incidence of being overwei ght in the Pittsburgh Epidemiology of Diabetes Complications (EDC) cohort ( n = 441) were compared with the general population (National Health and Nut rition Examination Survey [NHANES]). Factors associated with weight gain an d improved glycemic control were identified, and relationships among weight gain, glycemic control, and cardiovascular risk factors were examined over a 6.9 +/- 2.2-year period. RESULTS - At baseline, the prevalence of being overweight (BMI >27.8 kg/m(2 ) for men and >27.3 kg/m(2) for women) was 10.4 and 11.4%, respectively and was lower than the age- and sex-specific estimate for the general populati on (P < 0.05). The incidence of being overweight was comparable in men (12. 6%) and women (11.8%) and did not differ from the general population (P = 0 .98). Weight gain correlated with improvements in HbA(1c) (r = -0.21, P < 0 .001). Patients with the highest baseline HbA(1c) levels gained the most we ight and had the greatest improvement in glycemic control. A lower baseline BM1 was also associated with a greater improvement in glycemic control. We ight gain favorably influenced the lipid profile in the setting of improved glycemic control, but adversely influenced the lipid profile in the absenc e of improved glycemic control. Weight change was directly associated with blood pressure change, but the incidence of hypertension was more strongly influenced by the development of nephropathy. CONCLUSIONS - The prevalence of being overweight in ripe 1 diabetes remains lower than that in the general population. Moderate weight gain did not ad versely affect the cardiovascular risk profile in the setting of improved g lycemic control.