Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges

Abstract

Obesity affects large numbers of patients with type 1 diabetes (T1D) across their lifetime, with rates ranging between 2.8% and 37.1%. Patients with T1D and obesity are characterized by the presence of insulin resistance, of high insulin requirements, have a greater cardiometabolic risk and an enhanced risk of developing chronic complications when compared to normal-weight persons with T1D. Dual treatment of obesity and T1D is challenging and no specific guidelines for improving outcomes of both glycemic control and weight management have been established for this population. Nevertheless, although evidence is scarce, a comprehensive approach based on a balanced hypocaloric diet, physical activity and cognitive behavioral therapy by a multidisciplinary team, expert in both obesity and diabetes, remains as the best clinical practice. However, weight loss responses with lifestyle changes alone are limited, so in the “roadmap” of the treatment of obesity in T1D, it will be helpful to include anti-obesity pharmacotherapy despite at present there is a lack of evidence since T1D patients have been excluded from anti-obesity drug clinical trials. In case of severe obesity, bariatric surgery has proven to be of benefit in obtaining a substantial and long-term weight loss and reduction in cardiovascular risk. The near future looks promising with the development of new and more effective anti-obesity treatments and strategies to improve insulin resistance and oxidative stress. Advances in precision medicine may help individualize and optimize the medical management and care of these patients. This review, by gathering current evidence, highlights the need of solid knowledge in all facets of the treatment of patients with obesity and T1D that can only be obtained through high quality well-designed studies.

Obesity-Related Glomerulopathy: From Mechanism to Therapeutic Target

“…And among all of those therapies, personalized precision medicine may contribute to the medical management and care of obesity patients. 79 …”

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

“…The authors of The SWEET Registry demonstrated that switching from the multiple daily insulin injection to the continuous subcutaneous insulin infusion is significantly associated with an improvement in glycemic control but also with an increase in BMI in more than 4,000 youths with T1D ( 15 ). Interestingly, there are findings suggesting that in cases of co-occurring obesity and type 1 diabetes, making some changes to current therapy and using new long acting analogues as basal insulins, such as detemir, degludec and glar-300 may slightly prevent the weight gain associated with intensive insulin therapy ( 83 ). However, the study by Baskaran et al.…”

“…Obesogenic environment with easy availability of processed, high-energy foods, poor dietary habits and sedentary behaviour are the main factors causing obesity in the general population and they contribute significantly to weight gain among patients with type 1 diabetes ( 83 ). It is worth noting that patients with T1D treated with intensive insulin therapy focus more on the amount of carbohydrates in a meal rather than on balanced nutrition.…”

“…Many dietary interventions used for weight reduction have been studied in people with or without diabetes, but very few studies have focused strictly on patients with type 1 diabetes ( 99 ). It is known that reduction in total calorie intake plays a key role in weight loss in obese individuals, regardless of the occurrence of diabetes ( 83 ). Nevertheless, the recommended management of weight reduction in T1D is a low-calorie diet, which is based on the Mediterranean diet pattern, where 40-50% of energy comes from carbohydrates with a low glycaemic index and high content of fiber, 15-25% of energy comes from protein and 30-35% from fat (with high content of monounsaturated fats and low content of trans and saturated fats) ( 83 ).…”

“…It is known that reduction in total calorie intake plays a key role in weight loss in obese individuals, regardless of the occurrence of diabetes ( 83 ). Nevertheless, the recommended management of weight reduction in T1D is a low-calorie diet, which is based on the Mediterranean diet pattern, where 40-50% of energy comes from carbohydrates with a low glycaemic index and high content of fiber, 15-25% of energy comes from protein and 30-35% from fat (with high content of monounsaturated fats and low content of trans and saturated fats) ( 83 ). At this point it is worth mentioning that recently trending low carbohydrate or ketogenic diets should be used with caution in people with type 1 diabetes.…”