Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges
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Date
2021
Authors
Vilarrasa, Núria
San Jose, Patricia
Rubio, Miguel Ángel
Lecube Torelló, Albert
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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.
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Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2021, vol.14, p. 2807-2827