Endocrine Abstracts

In recent years there has been an increase in the incidence and prevalence of overweight and obesity around the world. Overweight and obesity are more common among people living with type 1 diabetes (T1D) than originally anticipated¹ . The SEARCH study found 21% of T1D patients are overweight² and 12.6%³ are obese. The T1D Exchange Study found an obesity rate of 13.1% in adolescents⁴ . The DCCT-EDIC Study found that the obesity prevalence, in the intensive treatment arm, increased from 1% at baseline in the DCCT to 31% at 12 years follow-up of EDIC⁵ . RENACED-DT1 found 42.4% of overweight and 8.1% of obesity in Mexican patients with T1D⁶ . Updated results (2022) will be presented during the meeting on the prevalence of obesity for the overall population and for T1D patients for Belgium, Kuwait and Mexico. Risk factors for overweight and obesity include non-physiological insulin administration route (subcutaneous), decrease in exercise due to hypoglycemia fear, excessive carbohydrate intake secondary to hypoglycemia, and hormonal changes¹ . Obesity increases the risk of cardiovascular disease. In people living with T1D it is difficult to quantify the degree of insulin resistance (IR). Those using >1 IU of insulin/kg/day are considered IR. IR and metabolic syndrome can also be calculated by the estimated glucose disposal rate eGDR (7), that takes into account the waist to hip ratio, presence or absence of hypertension and HbA1c. Patients with eGDR< 7.5 mg/kg/min are considered IR⁷ . Drugs used for type 2 diabetes treatment have been studied in T1D and have demonstrated decrease in weight and slight improvement in metabolic control in T1D subjects but are not approved for their use. It is imperative to address, prevent and find treatments for obesity in T1D.

References: 1. Van der Schueren B, Ellis D, Faradji RN, Al-Ozairi E, Rosen J, Mathieu C. Obesity in people living with T1D. Lancet Diabetes Endocrinol. 2021 Nov;9(11):776-785.

2. Mottalib A, Kasetty M, Mar JY, Elseaidy T, Ashrafzadeh S, Hamdy O. Weight Management in Patients with Type 1 Diabetes and Obesity. Curr Diab Rep. 2017;17(10):92. Published 2017 Aug 23.

3. Liu LL, Lawrence JM, Davis C, Liese AD, Pettitt DJ, Pihoker C, et al. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth Study. Pediatr Diabetes. 2010;11:4-11.

4. Minges KE, Whittemore R, Weinzimer SA, Irwin ML, Redeker NS, Grey M. Correlates of overweight and obesity in 5529 adolescents with type 1 diabetes: The T1D Exchange Clinic Registry. Diabetes Res Clin Pract. 2017;126:68-78.

5. Nathan DM, Zinman B, Cleary PA, Backlund JY, Genuth S, Miller R, et al. Modern-day clinical course of type 1 diabetes mellitus after 30 years’ duration: the diabetes control and complications trial/epidemiology of diabetes interventions and complications and Pittsburgh epidemiology of diabetes complications experience (1983-2005). Arch Intern Med. 2009;169:1307-16.

6. Faradji-Hazán RN, Valenzuela-Lara M, Díaz-Barriga Menchaca AP, Almeda-Valdes P, Antonio-Villa NE, Vidrio-Velázquez M, Islas-Ortega L, Martínez-Ramos-Méndez A, de la Garza-Hernández NE, Bustamante-Martínez JF, Sánchez-Ruiz KL, Yepez-Rodríguez AE, González-Gálvez G, Niño-Vargas RS, Sainz de la Maza-Viadero ME, Magis-Rodríguez C. Type 1 Diabetes Care in Mexico: An Analysis of the RENACED-DT1 National Registry. Rev Invest Clin. 2021 May 4;73(4):222-230.

7. Chillarón JJ, Goday A, Pedro-Botet J. Síndrome metabólico, diabetes mellitus tipo 1 y resistencia a la insulina [Metabolic syndrome, type 1 diabetes mellitus and insulin resistance]. Med Clin (Barc). 2008 Apr 5;130(12):466-70.