Overweight, obesity 'remains poorly managed' in patients with type 1 diabetes

In the United States, just half of patients with type 1 diabetes who had overweight or obesity received weight management lifestyle recommendations from providers or engaged in lifestyle modification, data show.

Researchers said the findings highlight the need for more comprehensive clinical guidelines with an emphasis on individualized medicine.

Up to 37% of people with type 1 diabetes have obesity, Michael Fang, PhD, MHS, an assistant professor at Johns Hopkins Bloomberg School of Public Health, and colleagues wrote in Annals of Internal Medicine.

“Survival has significantly improved in patients with type 1 diabetes over the past 2 decades, shifting the health profile of this population,” the researchers wrote. “However, current studies are based on selected populations and have not considered engagement in lifestyle modification.”

Fang and colleagues examined data from 128,571 adults who participated in the National Health Interview Survey.

From 2016 to 2021, the researchers found that 62% of people with type 1 diabetes had overweight or obesity compared with 64% of those without diabetes and 86% of those with type 2 diabetes. Of those with overweight or obesity, people with type 1 diabetes were offered lifestyle recommendations less frequently than those with type 2 diabetes but more frequently than people without diabetes.

“Rates of overweight and obesity in U.S. adults with type 1 diabetes are virtually identical to rates in the general adult population,” the researchers wrote. “Nearly two-thirds of U.S. adults with type 1 diabetes have overweight or obesity. However, only about half of these patients received lifestyle recommendations from providers or engaged in lifestyle modification.”

People with type 1 diabetes were the least likely to manage overweight or obesity with reduced caloric intake or increased physical activity.

The researchers wrote that, for those with type 1 diabetes, weight management “is complicated by insulin use.”

“Dietary and physical activity changes often require adjustments to insulin timing and dosage to prevent hypoglycemia,” they wrote. “Evidence-based guidance on lifestyle modification in type 1 diabetes remains sparse, potentially contributing to low rates of recommendation by providers and low engagement by patients. Robust clinical trials are needed to understand how to promote weight management safely and effectively in persons with type 1 diabetes.”

Fang and colleagues concluded that, for adults with type 1 diabetes in the United States, “the burden of overweight and obesity is substantial and remains poorly managed.”

“The development of more comprehensive clinical guidelines, with an emphasis on individualized patient education, may improve weight management in these patients,” they wrote.