Nutrition and Obesity in the Pathogenesis of Youth-Onset Type 1 Diabetes and Its Complications

Abstract

Since the 1980s, there has been a dramatic rise in the prevalence of overweight and obesity in pediatric populations, in large part driven by sedentary lifestyles and changing dietary patterns with more processed foods. In parallel with the rise in pediatric obesity in the general population, the prevalence of overweight and obesity has increased among children and adolescents with type 1 diabetes. Adiposity has been implicated in a variety of mechanisms both potentiating the risk for type 1 diabetes as well as exacerbating long-term complications, particularly cardiovascular disease. Treatment options targeting the unique needs of obese pediatric patients, both before and after diagnosis of type 1 diabetes, are limited. In this review, we discuss the history of the epidemiology of the obesity epidemic in the context of pediatric type 1 diabetes, highlight the possible role of obesity in type 1 diabetes pathogenesis and review the concept of "double diabetes". The impact of obesity at and after diagnosis will be discussed, including noted differences in clinical and biochemical markers, lipid abnormalities, and long-term cardiovascular complications. Finally, we will review the existing literature on pharmacologic and nutritional interventions as potential treatment strategies for youth with coexisting type 1 diabetes and obesity.

Keywords: cardiovascular complications; double diabetes; nutrition; obesity; type 1 diabetes.

Figure 1

Graphical representation of the proportion of reported normal weight, overweight, and obese youth with type 1 diabetes in each of these four registries: SEARCH (30), T1D Exchange (31), SWEET (32), and the DPV (33). The combined percentage of overweight and obese is shown. The proportion of youth who were underweight was available only for the SWEET registry. SWEET data was reported separately for males and females; a weighted average was obtained and is reported here.