Obesity in Patients with Type 1 Diabetes: Causes and Consequences

Obesity in patients with type 1 diabetes (T1D) is an increasingly important problem in diabetology. According to recent studies, the prevalence of overweight and obesity among patients with T1D varies from 15 to 50%. About a quarter of patients with T1D have metabolic syndrome. On the one hand, weight gain in patients with T1D reflects a general population trend. On the other hand, diabetes-related factors such as basal-bolus insulin therapy, chronic insulin overdose, hypoglycemia, and psychological problems associated with the disease can be promoters of weight gain. The relationship between T1D and obesity can be bidirectional. It has been established that overweight and obesity increase the risk of T1D, probably contributing to the autoimmune destruction of beta cells. Individuals with overweight and obesity, compared with patients with normal body weight, more often have insulin resistance, dyslipidemia and require higher doses of insulin to achieve targets of glycemic control. Obesity in individuals with T1D a risk factor for diabetic microvascular complications, arterial hypertension, chronic kidney disease, chronic heart failure, cardiovascular events, non-alcoholic fatty liver disease, and is associated with increased mortality. Therefore, maintaining normal body weight should be considered as an important option in the management of T1D. Education, moderate calorie restriction diet, and physical activity are the basis of the strategy for the prevention and treatment of obesity in individuals with T1D. Glucagon-like peptide-1 agonists, dual agonists of glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide, sodium-glucose cotransporter 2 inhibitors, and metformin are considered promising therapeutic options; however, data on the efficacy and safety of these drugs in patients with T1D are still limited. Experience in performing bariatric interventions in individuals with T1D and morbid obesity is accumulating. Further research is needed to create programs for the prevention and treatment of obesity in patients with T1D.