Obesity in type 1 diabetics a growing concern

3 minute read

New evidence and expert opinion suggests type 1 diabetes should no longer be considered only a thin person’s disease.

Overweight and obesity occur in people with type 1 diabetes at the same rate as the general non-diabetic public, a new US study reports.

Obesity was once rare in people with type 1 diabetes, but there is a growing body of evidence that obesity is becoming an issue in this population.

Dr Gary Deed, chair of the RACGP diabetes specific interest group, confirmed the growing prevalence of obesity in individuals with type 1 diabetes was an international concern.

“Unfortunately, obesity is now affecting many groups of patients, and type 1 diabetes patients are not immune to being overweight or obese,” Dr Deed told The Medical Republic.

The latest study published in the Annals of Internal Medicine, analysed survey data from almost 130,000 US adults over a five-year period.  According to data, 64% of adults without diabetes were overweight (BMI 25-30) or obese (BMI >30). Similarly, 62% of patients with type 1 diabetes were overweight or obese, while 86% of patients with type 2 diabetes were overweight or obese.

“Our study busts the myth that people with type 1 diabetes are not being affected by the global obesity epidemic,” said senior author Professor Elizabeth Selvin, Johns Hopkins Bloomberg School of Public Health, in a statement.

“These findings should be a wake-up call that we need to be aggressive in addressing the obesity epidemic in persons with type 1 diabetes.”

Additional data from the survey revealed that compared to patients with type 2 diabetes, a smaller proportion of type 1 diabetics had been advised to increase physical activity or reduce fat and/or caloric intake.

“The lack of evidence for safe, effective methods of diet- and exercise-based weight control in people with type 1 diabetes may be keeping doctors from recommending such methods,” said lead author Assistant Professor Michael Pang, also from the Johns Hopkins Bloomberg School of Public Health, in a statement.

“Large clinical trials have been done in type 2 diabetes patients to establish guidelines for diet- and exercise-based weight management, and we now need something similar for type 1 diabetes patients.”

Appropriately managing weight in type 1 diabetics can be complicated, experts say. Potential changes in diet or physical activity need to be done under close supervision, as adjustments to insulin timing and dosage may be needed to prevent hypoglycaemic attacks.

Because of this complexity, Dr Deed highlighted the need for early involvement of multidisciplinary care in these patients.

“People living with type 1 diabetes need to be educated about the risks, before the onset of obesity. If there is evidence of weight-related concerns, then they should be referred early to multidisciplinary teams to allow best practice interventions within a safe clinical model,” he told TMR.

Associate Professor Gary Kilov, founding member of the RACGP diabetes specific interest group, agreed obesity was a growing concern for people with type 1 diabetes – and that the effects may be more severe than first realised.

“We are seeing more patients with ‘double diabetes’ – that is, those with type 1 diabetes developing insulin resistance as they accumulate excess adiposity,” Associate Professor Kilov told TMR.

Annals of Internal Medicine 2023, online 14 February

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