Sociodemographic inequities and use of hybrid closed-loop systems associated with obesity in youth with type 1 diabetes

Aims: This study aimed to describe changes over time in rates of overweight and obesity and to identify factors associated with obesity in youth with type 1 diabetes. Methods: We analyzed data from 7360 diabetes medical visits among 2242 youth with type 1 diabetes for >= 1 year followed at a pediatric, tertiary care, academic medical center between 2018 and 2023. Multivariable generalized estimating equations (GEE) analysis and conditional logistic regression (CLR), where each patient had both control (not obesity) and case (obesity) status, were conducted. Results: Adjusted annual percentages of patients with obesity increased from 13.8 % in 2018 to 18.2 % in 2023 (P = 0.006); rates of overweight did not differ significantly over time. In multivariable GEE analysis, public insurance (P = 0.026), lower Child Opportunity Index score (P = 0.027), and use of hybridclosed-loop (HCL) systems (P = 0.023) were associated with obesity. In CLR, use of continuous glucose monitor and HCL systems and the sum of their effects (P = 0.002) were associated with obesity. Conclusions: This study revealed increasing rates of obesity in children with type 1 diabetes and identified sociodemographic and diabetes care-related factors associated with obesity, highlighting targets for intervention to decrease future risk of cardiovascular complications.