1438-P: Trends in Obesity and GLP-1RA Use among Youth and Adults with Type 1 Diabetes in U.S. Health System—2008–2022

Introduction & Objective: As data on medication use in type 1 diabetes (T1D) is scarce, we aimed to characterize trends in obesity and glucagon-like peptide-1 receptor agonists (GLP-1RA) use among US youth and adults with T1D from 2008-2022. Methods: We identified patients with T1D using a validated algorithm using deidentified electronic health record data from the Optum Labs Data Warehouse. Body mass index (BMI) categories were based on age- and sex-specific percentiles for youth (2-19 years) and WHO criteria for adults (≥20 years). We characterized trends in overweight and obesity, and GLP1-RA prescriptions by BMI categories from 2008-2010 to 2020-2022. Results: We included 159,879 patients with T1D (19% youth, mean age 39 years, 49% female, 77% non-Hispanic White). From 2008-2010 to 2020-2022, obesity in youth increased from 19% to 26% (P<.001), and severe obesity from 4% to 11% (P<.001) (Figure A). In adults, obesity rose from 28% in 2008-2010 to 37% in 2020-2022 (P<.001) (Figure B). There was a rapid uptake of GLP-1RA over the last 15 years, particularly in severe obesity (Figure C-D). In 2020-2022, GLP-1RA was used by 18% of youth and 34% of adults with severe obesity. Conclusion: Obesity has reached epidemic levels in patients with T1D. The off-label prescription of GLP-1RA significantly increased over time, especially in severe obesity. More data on GLP-1RA's effects in the T1D population is needed. Disclosure Y. Xu: None. M. Fang: None. J. Coresh: Consultant; SomaLogic, Healthy.io. M. Grams: None. E. Selvin: None. J. Shin: None.