Diana Tundidor

To describe the prevalence of overweight and obesity in adults living with type 1 diabetes and examine the association between biopsychosocial factors according to weight status. A single-center, cross-sectional study was conducted in adults with type 1 diabetes attending a tertiary hospital between 2018 and 2020. Participants completed an online survey with validated questionnaires to assess physical activity; measure anxiety and depression; evaluate the perception of health-related quality of life [Spanish version of Diabetes Quality of Life Questionnaire (EsDQoL)], assess eating disorders [Spanish version of Diabetes Eating Problem Survey (EPAD-R)] and measure neuroticism. Sociodemographic data and information from the last outpatient visit regarding diabetes history, long-term complications, current insulin therapy, anthropometric measurements and laboratory data were also included. Data from 459 surveys were available for analysis. Participants had a mean (SD) of age of 44.7 (14.0) years; 55.6% were women; BMI 26.0 (4.7) kg/m² and the HbA_1c was 7.57%. The prevalence of overweight (BMI 25-29.9 kg/m²) and obesity (BMI > 30 kg/m²) was 38.8% and 14.8%, respectively, with 10.6% being class I (30-34.9 kg/m²), 2.2% class II (35-39.9 kg/m²) and 2.0% class III (>40 kg/m²). Older age, living with a child/children, a higher EPAD-R score, a higher total insulin doses, receiving lipid-lowering therapy, and a higher EsDQoL score in the diabetes-related worries dimension were associated with a greater likelihood of living with obesity. Overweight and obesity are highly prevalent among adults living with type 1 diabetes, and the identified biopsychosocial factors reveals how excess weight arises from complex interactions among demographic, clinical, and psychological influences.

Objectives: To assess retinal microvascular changes in patients with Grade II and III obesity before and after bariatric surgery using Optical Coherence Tomography Angiography (OCTA), and to compare these metrics with age- and sex-matched healthy controls. Methods: Prospective, consecutive, longitudinal cohort study with a 12-month follow-up. Grade II and III obese patients scheduled for bariatric surgery underwent comprehensive ophthalmic examinations, including OCTA imaging, prior to the surgery and postoperatively at 1 month, 6 months, and 12 months post-surgery. Results: A total of 43 eyes from 43 patients with obesity (one eye per patient) were included at baseline. At 12 months post-surgery, there was a significant increase in vessel density (VD) (16.70 vs. 17.68; p < 0.01) and perfusion density (PD) (0.406 vs. 0.433; p < 0.01), reaching values comparable to those of the control group (17.73 and 0.434, respectively). Significant reductions were also observed in body mass index (BMI) (43.74 vs. 29.53; p < 0.01), body weight (122.44 kg vs. 81.90 kg; p < 0.01), and intraocular pressure (IOP) (15.72 mmHg vs. 14.16 mmHg; p < 0.01). Conclusions: This study demonstrates a compelling association between obesity and retinal microvascular impairment, highlighting the efficacy of bariatric surgery not only in achieving substantial weight loss but also in improving the retinal perfusion of these patients, achieving metrics at 12 months comparable to age- and sex-matched healthy controls at baseline. These findings raise the hypothesis of the potential utility of OCTA as a monitoring tool for tracking the microvascular status in patients with obesity undergoing bariatric surgery in a longitudinal manner.

The CONCEPTT trial compared real-time Continuous Glucose Monitoring (RT-CGM) to capillary glucose monitoring in pregnant women with type 1 diabetes. We analyzed CGM and glycated hemoglobin (HbA _1c ) measures in first ( n = 221), second ( n = 197), and third ( n = 172) trimesters, aiming to examine target glucose attainment and associations with pregnancy outcomes. CGM targets were Time-in-range (TIR) > 70%, Time-above-range (TAR) 1c targets < 6.5% (National Institute for Health and Care Excellence [NICE]) and HbA _1c < 6.0% in second and third trimesters (American Diabetes Association [ADA]). TIR/TAR/TBR targets were achieved by 7.7/14.5/30.3% participants in first, 10.2/14.2/52.8% in second, and 35.5/37.2/52.9% in third trimesters. CGM target attainment was low but increased during pregnancy and with RT-CGM use. In the adjusted analyses, achieving TBR target was associated with a higher risk of pre-eclampsia and neonatal hypoglycemia. ADA HbA _1c target attainment was low and unchanged during pregnancy (23.5/27.9/23.8%) but increased with RT-CGM use. In the adjusted analyses, HbA _1c target attainment was associated with a lower risk of preterm birth, large-for-gestational age and neonatal hypoglycemia. We conclude that CONCEPTT trial participants had a low rate of CGM and of HbA _1c target attainment. Attainment of CGM and NICE HbA _1c targets increased throughout gestation and all targets (both NICE/ADA HbA _1c and CGM) were more likely to be achieved by RT-CGM users, at 34 weeks' gestation. ADA HbA _1c target achievement was independently associated with better perinatal outcomes, while the independent association of TBR target achievement with increased risk warrants further study. ClinicalTrials.gov Registration Identifier NCT01788527.