Type 1 diabetes presents special challenges to weight management
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Although much attention has focused on weight gain in type 2 diabetes, more research is needed on weight management interventions for people with type 1 diabetes, according to a speaker.
“The management of obesity and the prevention of obesity is more and more of a key element of treating people with diabetes,” Bart Van der Schueren, MD, PhD, assistant professor in the department of endocrinology at University Hospitals Leuven in Belgium, said during a press conference at the European Association for the Study of Diabetes virtual meeting. “We often think of those who have type 2 diabetes, but actually, the obesity pandemic is well installed in people that are living with type 1 diabetes. This is often forgotten.”
The prevalence of overweight or obesity among adults with type 1 diabetes varies by country. For example, among people with type 1 diabetes in Austria, 39.8% have overweight and 14% obesity compared with 33.1% and 13.8%, respectively, of the overall population. In contrast, in the U.S., rates of overweight and obesity are lower among those with type 1 diabetes — 29.7% and 21.6%, respectively — compared with 31.1% and 42.5% in the overall population.
Van der Schueren said data are lacking on general prevalence of overweight and obesity among those with type 1 diabetes.
“One of the main reasons why we’re bringing up this topic is to bring this to the attention of the larger audience,” Van der Schueren said. “Very little is currently known in terms of prevalence, but also disparity is becoming a problem. For example, interestingly, in Mexico, where obesity is a very big problem in the general population, only 8% of the patients living with type 1 diabetes meet obesity criteria. That might mean that this has something to do with disparity.”
Intensive insulin therapy is a major driver of weight gain in type 1 diabetes.
“Although there is no debate about the benefit of tight glucose control for the prevention of complications in this population, the intensification of insulin therapy required to achieve stringent glucose control often comes at the cost of weight gain,” van der Schueren and colleagues wrote in a review article simultaneously published in The Lancet Diabetes & Endocrinology.
Other possible reasons for weight gain in type 1 diabetes include defensive snacking to avoid hypoglycemia after exercising, avoiding exercise altogether, changes to the growth hormone or insulin-like growth factor system, age, duration of diabetes and genetic disposition.
People with type 1 diabetes face several specific challenges to weight management, van der Schueren said. Fear of hypoglycemia may make some hesitant to adhere to diet or exercise, potentially inducing weight gain. Weight-loss medications come with barriers to use beyond cost and access. SGLT2 inhibitors may increase diabetic ketoacidosis risk, and GLP-1 receptor agonists require additional injections.
Van der Schueren noted a lack of studies examining bariatric surgery for people with type 1 diabetes. However, some studies have found an association between bariatric procedures and increased risks for hypoglycemia and DKA.
“This review is part of a larger effort to draw attention to the topic of weight management in people living with type 1 diabetes,” the researchers wrote. “We hope it will foster further research, because only knowledge will enable to us to improve clinical care for people with type 1 diabetes. Increased knowledge will also help in the development of evidence-based consensus guidelines to help clinicians in their daily practice.”
Reference:
Van der Schueren B, et al. Lancet Diabetes Endocrinol. 2021;doi:10.1016/S2213-8587(21)00246-1.
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Van der Schueren B. Obesity in people living with type 1 diabetes. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 27-Oct. 1, 2021 (virtual meeting).
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