In a recent review published within the International Journal of Obesity, researchers reviewed recent advancements in epidemiological data about type 1 diabetes (T1D) and weight disorders. They explore the challenges scientists and clinicians face in studying and treating these associations. Their findings debunk multiple myths regarding T1D, most notably that the chronic condition only affects lean adolescents. Finally, this review presents recommendations for therapeutic interventions against T1D and guidelines for future research on the subject.
Study: The emergence of obesity in type 1 diabetes. Image Credit: Monkey Business Images
Obesity and diabetes – a transient history
Weight-related disorders, probably the most common of that are obese and obesity, present substantial clinical and socioeconomic burdens globally. Greater than 1 billion individuals worldwide suffer from obesity, with the condition estimated to have claimed greater than 5 million lives in 2019 alone. Alarmingly, changing trends in weight loss plan and physical activity are driving significant increases in obesity rates, with current obesity prevalence almost triple that of 1975. Western countries are worst affected by this negative trend, with reports highlighting that United States (US) obesity rates have seen a fourfold increase since 1980.
In comparison with the way more prevalent type 2 diabetes (T2D), type 1 diabetes (T1D) is a rare, normally genetic condition affecting between 3-10% of individuals with diabetes. It’s regarded as an autoimmune disorder and is characterised by the reduced or complete inability of the pancreas to supply insulin, leading to a toxic buildup of sugar in a patient’s bloodstream. Because its onset was historically noted in adolescents, the condition has been called ‘juvenile’ diabetes, but recent research has discovered that T1D can develop in individuals of any age group.
Within the US, T1D is reported to affect 5.6% of all diabetic patients. A well-liked clinical notion was that T1D affects only lean individuals, with obese and obese individuals proof against the condition. Given this notion and the post-coronavirus-2019 (COVID-19) trend of accelerating obese prevalence, T1D prevalence was expected to cut back. Nevertheless, recent research has debunked this view and located a positive cyclic feedback association between extra weight disorders and T1D. This results in predictions that T1D prevalence will increase from its current 3.7 million to greater than 17 million by 2040.
T1D stays the less-studied diabetes version, with research into the disease a fraction of that into T2D. Improving skilled and public knowledge concerning the disease, its causative agents, and optimal management strategies will allow clinicians to higher prepare for the upcoming surge in T1D patients and improve the standard of life for all patients of this chronic condition.
In regards to the study
The current review goals to elucidate current knowledge on the connection between T1D and obesity, summarise the drivers of each conditions and discuss the most effective evidence-backed management strategies for treating T1D. The PubMed (MEDLINE) online scientific repository was looked for all publications researching obesity, T1D, their known contributors and risk determinants, and interventions against each conditions from database initiation till June 2023. Greater than 120 papers were identified for descriptive summarization and discussion following title, abstract, and full-text screening.
The reviewed literature was summarized under 4 primary subheadings – 1. Multinational patterns of obesity with type 1 diabetes, 2. The distinctive biopsychosocial aspects contributing to increased obesity in type 1 diabetes, 3. Treatments for obesity in patients with type 1 diabetes, and 4. Future directions for obesity management in type 1 diabetes.
Study findings
Unlike previously thought, obese and obesity are significantly positively related to T1D. Research has revealed that in adolescents between the ages of 16 and 19, every incremental standard deviation (SD) from mean body mass index (BMI) was related to a 25% increased risk of developing T1D. These findings have been validated by Mendelian randomization studies and genome-wide association studies (GWAS).
Encouragingly, these GWAS also elucidated an unexpected finding – children with severe obesity (and, subsequently, high T1D risk) could drastically reduce their T1D risk by as much as 22% for each 10% weight reduction. This implies the existence of a critical window of opportunity wherein weight management interventions before the onset of T1D could potentially prevent the event of the condition, directly improving the futures of hundreds and even thousands and thousands of would-be diabetic patients.
This review highlights significant confound between metrics and methodologies used to measure obese/obesity and T1D globally, as noted from the SEARCH (US-based), Diabetes Patienten Verlaufsdokumentation (Europe-based), Type 1 Diabetes Exchange (US-based), all of which found positive associations between obesity and T1D, but with prevalence ranging for just 15.3% to 36% or more. Similarly, the SWEET cohort (Europe, India, and Canada) documented a 10-trend of reduced childhood and adolescent obesity, whereas the Diabetes Control and Complications Trial (DCCT) found no such reductions. Finally, UK-based studies have found no association between obesity and T1D, contradicting the previously mentioned cohorts.
“Future comparative studies should assess the applicability of various obesity measurements in phenotyping obesity in T1D to make sure reliable epidemiological data.”
The previous few a long time have seen unprecedented increases ill behaviors, most notably within the consumption of energy-dense foods (e.g., the Western weight loss plan) and shifts to highly sedentary lifestyles, especially following the COVID-19 pandemic and its associated ‘work-from-home.’ These trends have defined the obesogenic (obesity-inducing) landscape, which is now known to arise from a mixture of genetic, political, socioeconomic, and cultural aspects. Unfortunately, despite recent risk contributors being discovered almost each day, most haven’t received adequate attention, each from clinicians and policymakers.
“First, there stays an inadequate comprehension of obesity within the pathogenesis of T1D, which can impede effective prevention and treatment strategies. Second, treating obesity is complicated by intensive insulin therapy, the usual of look after T1D, which paradoxically causes weight gain, making a difficult dilemma for achieving weight management goals. Third, health disparities in T1D result in a large variation in disability-adjusted life years (DALY), with unaddressed gaps.”
Notably, T1D is characterised by the induction of β-cell inflammation. This condition is exacerbated by obesity attributable to the latter’s comorbidities, including lipotoxicity, mitochondrial dysfunction, glucotoxicity, adipose tissue damage, endocrine alterations, and the recently described imbalances in gut microbial communities. The interplay between these aspects induces synergistic effects far more pronounced than any taken in isolation. Current research fails to include these effects in its predictions and intervention recommendations, often leading to suboptimal outcomes. Future clinical research should account for the holistic effects of T1D and diabetes and aim to treat body conditions fairly than concentrate on one at the fee of the opposite.
A perfect example of that is exercise, the first non-clinical intervention in obesity treatment. While high-intensity exercise significantly promotes weight reduction, subjecting a T1D patient to vigorous physical activity can sometimes cause more harm than good since it increases hyperglycemia (high blood sugar), the primary T1D complication. If used as an intervention, exercise have to be tailored to account for each obesity and T1D (e.g., low-intensity walking versus high-intensity running).
“Breakthroughs in insulin pumps, continuous glucose monitoring, and sensor-automated insulin devices help control glycaemic levels around most types of exercise and hold probably the most optimistic hope in exercise safety.”
Similarly, dietary and dietary interventions tailored toward treating obesity may sometimes aggravate T1D, leading to increases in pharmacotherapeutic interventions (insulin injections). Dietary interventions have to be fine-tuned on a per-patient basis fairly than a ‘one-size-fits-all’ medical nutrition therapy (MNT) approach.
Using pharmacological interventions should similarly be extensively tested before use. Incretin mimetics (receptor agonists that increase insulin release from the pancreas) needs to be used with care lest they cause unexpected weight reduction outcomes. The importance of patient education and adaptable care as a growing body of evidence suggests that patient-reported symptoms can closely resemble clinically diagnosed medical profiles and could be used as preliminary proxies for the latter.
“Finally, attention to healthcare inequality should intensify. The evolving technological innovations and limited availability of off-label medications are progressively tilting towards a first-world-centric resolution.”
A growing body of research highlights that socioeconomically backward communities and racial minorities are the worst affected by T1D and obesity, a phenomenon aggravated by their being at increased risk of each conditions. Policymakers and pharmaceutical corporations should ensure fair and cost-effective healthcare administration to all patients, regardless of the dimensions of their wallets.
Conclusions
T1D has historically received far less clinical and scientific interest than its far more prevalent T2D counterpart, leading to quite a few myths and misinformation about its prevalence, associated risk aspects, and optimal treatment. Recent research has begun debunking these myths, revealing that the prevalence of T1D is higher than previously thought, and its incidence is anticipated to surge in the approaching years. Unlike previously assumed, T1D isn’t restricted to lean individuals. As a substitute, its associations with weight abnormalities are synergistic and profound. Future research, policy, and interventions have to be patient-specific and tailored to handle T1D, obesity, and their comorbidities concurrently.
“On a systemic level, an aligned multistakeholder initiative is required to make sure the true value of the worldwide motion plan on this T1D-obesity burden.”