Gender differences in psychosocial outcomes according to BMI among adults living with type 1 diabetes: A cross-sectional BETTER analysis

Abstract

Aims: The prevalence of overweight and obesity in people with type 1 diabetes has increased significantly, presenting additional psychosocial challenges that vary by gender. This study investigates the relationship between BMI and psychosocial outcomes in adult men and women with type 1 diabetes. Methods: This cross-sectional analysis used data from people with type 1 diabetes in the BETTER registry, stratified by gender and categorized into BMI groups (<25, 25–29.9, ≥ 30 kg/m2). Psychosocial outcomes included depression, diabetes distress, and stigmatization related to diabetes. One-way ANOVA assessed differences between BMI groups by gender. Multivariable logistic regression then analyzed gender differences within each BMI group, adjusting for age and HbA1c. Results: Among 1028 participants (66 % women, mean BMI 26.4 ± 5.1 kg/m2, mean age 45.4 ± 15.0 years), 460 adults (45 %) had a BMI < 25, 356 (35 %) between 25–29.9, and 212 (21 %) ≥ 30 kg/m2. Women in the ≥ 30 kg/m2 group, compared to the < 25 kg/m2 group, had more symptoms of depression, more drug prescriptions for depression/anxiety, and higher diabetes distress (p < 0.001 for all). In men, psychosocial outcomes did not differ significantly across BMI groups. Multivariable regression showed women were more likely than men to report prescriptions for depression/anxiety and high diabetes distress, particularly in the higher BMI groups. Conclusions: In adults living with type 1 diabetes, higher BMI is associated with adverse psychosocial outcomes, particularly in women. Gender-specific interventions addressing mental health, stigma, and weight management could be beneficial to improve overall well-being.