Preventing obesity in people with type 1 diabetes is a difficult but not impossible balance

People with type 1 diabetes (T1D), in which the pancreas produces little or no insulin, need to use alternative insulin injections to control blood glucose levels, and this insulin therapy itself is weight gain and subsequent obesity. Increases the risk of.

However, the author of the new review Lancet Diabetes and Endocrinology Presented at this year’s European Diabetes Society (EASD) Online Annual Meeting as part of a special Lancet-EASD Obesity Symposium, these patients are able to manage their diabetes. weightWhile seeking further research on the specific needs of this patient group.

“The challenge for people living with T1D today is to achieve them at the same time. Blood sugar When Weight control, This is a difficult task as an enhancement Insulin Treatment as the condition progresses is considered to be the greatest driver of weight gain, “explains Professor Bad van der Schulen, co-author of the University Hospital Leuven in Leuven, Belgium. increase.

For many years, patients with T1D, which accounts for about 10% of the world’s diabetes cases, were considered lean or of normal weight.But people with T1D just General population, Increases the risk of heart attack, stroke, and various cancers, among other conditions.

This review explores some of the reasons insulin therapy itself increases the risk of weight gain in T1D patients. This includes things like helping the body “save” calories as glycemic control improves, and how insulin injections mean bypassing the liver. Insulin levels in peripheral tissues can become excessively high, affecting body composition and leading to excess fat accumulation.

Another theory about the reason Insulin therapy Inducing weight gain is a central challenge faced daily by patients with type 1 diabetes. To avoid hypoglycemia (episodes of hypoglycemia). Many people with T1D employ “defensive snacks” before periods of activity or exercise to ensure that they are not at risk for hypoglycemia. This can lead to overconsumption, weight gain, and obesity, just like any other person who burns more calories than they use.

Various studies have demonstrated the harmful effects of obesity in patients with T1D. Approximately 26,000 T1D patients (mean age 33 years) registered in the Swedish National Diabetes Registry from 1998 to 2012 to assess the risk of death from cardiovascular disease (CVD), major CVD events, and hospitalization for heart failure. , 45% of women) study (HF), and total mortality, mortality from major CVD, HF, CV, and increased risk of mortality with increasing BMI, more relevant in men than in women I showed that. Obesity can also increase the risk of many cancer and mental health problems in all people.

Unfortunately, there are no specific goals or strategies for weight management for people living with T1D. For example, physical activity can cause patients to worry about hypoglycemia, as is one of the many calorie restriction diet plans available today.

The author states: “One of the most effective strategies to prevent weight gain in T1D patients is to provide additional nutritional education, which allows insulin doses to be accurately adjusted to levels that mimic physiological levels. However, the resources to provide such education are scarce in many situations. “

The authors are also investigating the use of adjuvant (additional) therapy in weight management in T1D patients. Commonly used drugs for the treatment of type 2 diabetes, such as metformin, and glucagon-like peptide 1 (GLP-1) receptor agonists (including liraglutide) and sodium glucose transport protein-2 (SGLT2) inhibitors. All of the much newer classes of drugs have been shown to cause weight loss in T1D patients. It also describes pramlintide, a synthetic analog of human amylin (secreted by insulin) that slows gastric emptying, suppresses glucagon secretion, and reduces food intake. However, these medications have side effects that must be considered.

Obesity surgery is also discussed in the review, and while this procedure significantly reduces obesity complications (such as cardiovascular disease and death) in T1D patients, it may also increase the risk of hypoglycemia and substance abuse. Overall results are promising, but patients with T1D require larger trials.

The authors also accurately understand whether and / or excessive accumulation of body fat in people living with T1D, which ultimately leads to overweight and obesity, to understand if and how these processes differ. Seeking further research to “better understand” the prevalence of obesity from the general public.

They say: “New therapies and technologies should focus not only on improving glycemic control, but also on reducing weight control in people living with T1D. To some extent, the development of new insulins that better target the liver. But we need better education and support for people. When it comes to matching insulin doses to food intake and exercise, it can already be of great help to help people with T1D manage their weight. There is sex. “

They add: “Adjuvant therapies that can improve glycemic control through insulin-independent pathways also need to be investigated. To assess the exact magnitude of the overall health consequences of people suffering from both overweight and overweight. Therefore, more research is needed. obesity And T1D. Existing evidence has already shown that unwanted weight gain is the reason for concern when treating patients with type 1 diabetes, but better data is needed. ”

Weight loss of 15% or more should be a central focus of type 2 diabetes management

Quote: Preventing obesity in people with type 1 diabetes is difficult but not impossible Balance (October 1, 2021) October 1, 2021 Obtained from obesity-people-diabetes-difficult.html

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