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Review
. 2021 Jun 21:14:2807-2827.
doi: 10.2147/DMSO.S223618. eCollection 2021.

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

Nuria Vilarrasa  1   2 , Patricia San Jose  1 , Miguel Ángel Rubio  3 , Albert Lecube  2   4   5
Affiliations
Review

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

Nuria Vilarrasa et al. Diabetes Metab Syndr Obes. .

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.

Keywords: bariatric surgery; dual diabetes; insulin resistance; metabolic syndrome; obesity; type 1 diabetes.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
In patients with type 1 diabetes adipose tissue deposits produce adipokines and inflammatory cytokines that induce insulin-resistance contributing to the development of cardiometabolic complications. The coexistence of these clinical characteristics of type 2 diabetes in patients with type 1 diabetes has been referred to as double diabetes.
Figure 2
Figure 2
Illustration of the main modifiable and endogenous biological factors implicated in obesity etiology.
See this image and copyright information in PMC

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