{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T19:28:00Z","timestamp":1787254080394,"version":"build-2736575974"},"reference-count":40,"publisher":"American Diabetes Association","issue":"9","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Breakthrough T1D","award":["3-SRA-2025-1738-S-B"],"award-info":[{"award-number":["3-SRA-2025-1738-S-B"]}]},{"name":"NIH","award":["R01 DK121843"],"award-info":[{"award-number":["R01 DK121843"]}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Elevated BMI is associated with increased risk of progression to stage 3 type 1 diabetes (T1D). We tested whether normalization of BMI is associated with lower stage 3 risk among autoantibody-positive individuals with overweight or obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We studied 833 autoantibody-positive participants in the TrialNet Pathway to Prevention study with overweight or obesity at baseline. Cumulative incidence of stage 3 T1D was evaluated using Cox proportional hazards models. Reported P values were adjusted for baseline age, BMI z score, and T1D stage, unless otherwise noted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>During follow-up, BMI normalized in 26.8% of participants and was associated with a lower risk of progression to stage 3 T1D (hazard ratio 0.516, P &amp;lt; 0.001) over a median follow-up time of 4.1 years. This association was primarily observed in youth (n = 421, hazard ratio 0.497, P = 0.001), including boys &amp;lt;12 years old (n = 140, P &amp;lt; 0.001) and girls \u226512 years old (n = 73, P = 0.043), but not in adults (n = 412, P = 0.130). BMI normalization was also associated with a lower risk of transition from stage 1 to stage 2 and from stage 2 to stage 3, but not clearly from stage 0 to stage 1 (P = 0.010, P = 0.003, and P = 0.051, respectively, adjusted for baseline age and BMI z score). In exploratory models, adjustment for insulin sensitivity\/resistance indices or oral disposition index weakened the association between BMI normalization and lower progression risk, whereas adjustment for insulin secretion, glycemia-adjusted C-peptide, or progression-risk indices generally strengthened it.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Among autoantibody-positive individuals with overweight or obesity, BMI normalization was associated with a 48.4% lower risk of clinical T1D, primarily in youth.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-0833","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T17:23:48Z","timestamp":1784222628000},"page":"1729-1737","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["BMI Normalization Is Associated With Lower Risk of Progression to Type 1 Diabetes, Primarily in Youth"],"prefix":"10.2337","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5871-4645","authenticated-orcid":false,"given":"Maria J.","family":"Redondo","sequence":"first","affiliation":[{"name":"Baylor College of Medicine 1 , Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cuthbertson","sequence":"additional","affiliation":[{"name":"Health Informatics Institute, Morsani College of Medicine, University of South Florida 2 , Tampa, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raquel","family":"Gupta","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine 1 , Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro F.","family":"Siller","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine 1 , Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sridevi","family":"Devaraj","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine 1 , Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendra","family":"Vehik","sequence":"additional","affiliation":[{"name":"Health Informatics Institute, Morsani College of Medicine, University of South Florida 2 , Tampa, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba M.","family":"Ismail","sequence":"additional","affiliation":[{"name":"Indiana University 3 , Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashok","family":"Balasubramanyam","sequence":"additional","affiliation":[{"name":"Baylor College of Medicine 1 , Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"2026082014534027400_B1","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.2337\/dc23-0635","article-title":"Hybrid HbA1c: a real-world observational study","volume":"46","author":"Crabtree","year":"2023","journal-title":"Diabetes Care"},{"key":"2026082014534027400_B2","doi-asserted-by":"crossref","first-page":"1709","DOI":"10.1007\/s00125-025-06434-2","article-title":"Type 1 diabetes prediction in autoantibody-positive individuals: performance, time and money matter","volume":"68","author":"Ferrat","year":"2025","journal-title":"Diabetologia"},{"key":"2026082014534027400_B3","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1056\/NEJMoa1902226","article-title":"An anti-CD3 antibody, teplizumab, in relatives at risk for type 1 diabetes","volume":"381","author":"Herold","year":"2019","journal-title":"N Engl J Med"},{"key":"2026082014534027400_B4","doi-asserted-by":"crossref","first-page":"1917","DOI":"10.2337\/dc18-0494","article-title":"Low-dose anti-thymocyte globulin (ATG) preserves \u03b2-cell function and improves HbA1c in new-onset type 1 diabetes","volume":"41","author":"Haller","year":"2018","journal-title":"Diabetes Care"},{"key":"2026082014534027400_B5","unstructured":"Jacobsen\n              LM\n            , SchatzDA, HeroldKC, SkylerJS.\n          Prevention of Type 1 Diabetes. 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