Temporal patterns in overweight and obesity in Type 1 diabetes

Abstract

Background Time trends in overweight and obesity in the general population have been well documented; however, temporal patterns in type 1 diabetes (T1D) have not been thoroughly investigated. We therefore assessed temporal patterns in overweight and obesity and predictors of weight change in 589 individuals from the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study, a cohort of childhood onset T1D. Methods Participants were first seen in 1986–1988, when mean age and diabetes duration were 29 and 20 years, respectively, and biennially thereafter for 18 years. Overweight was defined as 25≤BMI<30 kg/m2. Obese was defined as a BMI≥30 kg/m2. Results At baseline, the prevalence of overweight and obesity were 28.6% and 3.4%, respectively. After 18 years of follow-up, the prevalence of overweight increased by 47% while the prevalence of obesity increased 7-fold. Seven percent were on intensive insulin therapy (≥3 insulin injections per day or on insulin pump) at baseline; by 2004–2007, this was 82%. Predictors of weight change were a higher baseline HbA1c, symptomatic autonomic neuropathy (inversely), overt nephropathy (inversely), and going onto intensive insulin therapy during follow-up. Conclusion These data demonstrate dramatic weight gain in T1D and underscore the complexity of weight change in this disease.

Effects of exogenous human insulin dose adjustment on body mass index in adult patients with type 1 diabetes mellitus at Kalafong Hospital, Pretoria, South Africa, 2009 - 2014

“…The current study also identified any insulin exposure adjusted for other covariates and baseline BMI to be significant predictors of weight gain in the cohort of patients observed. These findings are consistent with those of Conway et al [1] in a longitudinal study to determine the prevalence and incidence of overweight and obesity in a cohort of 589 type 1 DM patients followed up over at least 18 years.…”

“…The finding that a higher baseline HbA1c predicted a larger and statistically significant increase in subsequent BMI in patients exposed to the twice-daily biphasic insulin dosage regimen when compared with the basal NPH plus prandial regular insulin regimen group in this study population was consistent with observations by Nansel et al, [10] Williams et al [11] and Conway et al [1] These researchers found that IIT and a higher baseline HbA1c were predictors of weight gain in patients in their respective settings. The current study also identified any insulin exposure adjusted for other covariates and baseline BMI to be significant predictors of weight gain in the cohort of patients observed.…”

“…Conclusions can also be drawn that an increase in BMI is consistent with improvements in blood glucose control in this setting. Also, strategies already in place at the Kalafong Diabetes Clinic to control weight gain through advice on physical exercise, dietary and lifestyle counselling as part of clinical management should continue and be strengthened further to sustain optimal BMI outcomes in type 1 DM patients in this setting.The finding that a higher baseline HbA1c predicted a larger and statistically significant increase in subsequent BMI in patients exposed to the twice-daily biphasic insulin dosage regimen when compared with the basal NPH plus prandial regular insulin regimen group in this study population was consistent with observations by Nansel et al, [10] Williams et al [11] and Conway et al [1] These researchers found that IIT and a higher baseline HbA1c were predictors of weight gain in patients in their respective settings. The current study also identified any insulin exposure adjusted for other covariates and baseline BMI to be significant predictors of weight gain in the cohort of patients observed.…”

“…However, patients on IIT have been observed to experience weight gain over time, regardless of the level of glycaemic control achieved. [1] Several mechanisms have been postulated to account for this, including snacking outside normal mealtimes to offset IIT-associated hypoglycaemia. In addition, anabolic effects of insulin on skeletal muscle, alterations in the regulators of adiposity, and the resolution of glycosuria leading to conservation of calories in previously poorly controlled patients with DM are also hypothesised as mechanisms of weight gain over time in type 1 DM.…”

Potential Benefit of Postprandial Exercise for Those with Type 1 Diabetes

“…Considering the annual cost of type 1 diabetes care to the individual, estimated to be $6,288 per year in a 2010 paper [2] and the increasing price of insulin [3], effective and realistic low/no cost strategies to improve glycemic control are needed not only to reduce the expense to the individual with type 1 diabetes, but also to prevent the short and long term complications of poor glycemic control and minimize the negative consequences of high insulin dosages, such as possible weight gain [4].…”