Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children – From Disease Pathogenesis to Complications

Abstract

The prevalence of overweight and obesity among youth patients with diabetes type 1 is increasing. It is estimated, that even up to 35% of young patients with this type of diabetes, considered so far to be characteristic for slim figure, are overweight or even obese. General increase of obesity in children’s population complicates differential diagnosis of the type of diabetes in youths. Coexistence of obesity has clinical implications for all stages of diabetes course. It is confirmed that obesity is the risk factor for autoimmune diabetes, and is connected with the earlier onset of diabetes in predisposed patients. Many diabetic patients with obesity present additional risk factors for macroangiopathy, and are recognised to present metabolic syndrome, insulin resistance, and typical for diabetes type 2 - polycystic ovary syndrome, or non-alcoholic fatty liver disease. The prevalence of obesity rises dramatically in adolescence of diabetic child, more often in girls. It has negative impact on metabolic control, glycaemic variability and insulin demand. The risk for microangiopathic complications increases as well. The treatment is difficult and includes not only insulinotherapy and non-pharmacological trials. Recently treatment of insulin resistance with biguanids, and treatment with typical for type 2 new diabetes drugs like GLP-1 analogues, SGLT-2 receptor inhibitors, or even cases of bariatric surgery also has been reported.

Body mass index, basal insulin and glycemic control in children with type 1 diabetes treated with the advanced hybrid closed loop system remain stable - 1-year prospective, observational, two-center study

“…The prevalence of overweight and obesity among youth with type 1 diabetes (T1D) is steadily increasing and reached even 35% in recent reports ( 1 – 4 ). Excessive body weight complicates attainment of recommended glucose control targets and is often tied with use of higher daily and basal insulin doses ( 5 , 6 ).…”

Posttraumatic stress disorder and diabetes-related outcomes in patients with type 1 diabetes

“…It is well-established that PTSD is associated with a reduced healthy diet and physical activity, as well as increased obesity 16 . The co-existence of obesity at a young age can have a negative clinical impact on all stages of diabetes course, which in turn could induce prolonged hospital stay 46 .…”

Advanced Glycation End Products and Inflammation in Type 1 Diabetes Development

“…Factors such as obesity, BMI and energy intake also appear to influence the progression of type 1 diabetes, with higher BMI and obesity associated with earlier onset of T1D [ 32 , 33 , 34 ] and progression of islet autoimmunity [ 35 ]. This has been attributed to factors such as insulin resistance and chronic inflammation acting as accelerating factors in type 1 diabetes pathogenesis [ 33 , 36 ]. Although clinical management of individuals with T1D continue to improve, individuals diagnosed with T1D are still limited to exogenous insulin therapy, with only a few individuals (18% of children and 13% of adults) achieving the recommended glycemic target of <7% for glycated hemoglobin (HbA1c) [ 37 , 38 ].…”

“…Increased prevalence of obesity in individuals with T1D could also increase the likelihood of developing liver diseases such as Non-alcoholic steatohepatitis (NASH) and Non-alcoholic fatty liver disease (NAFLD) [ 109 , 110 ], impacting AGEs clearance. Obesity has been increasingly recognized to be associated with earlier onset of T1D and development of a “T1D like” phenotype characterized by immune infiltration and islet autoimmunity [ 36 ]. Perhaps not surprising is that lower dietary AGE intake improves insulin sensitivity in overweight individuals [ 111 , 112 ] as well as decreasing chronic low-grade inflammation.…”