Treatment of obesity in people with type 1 and type 2 diabetes

Abstract

Obesity, a multifactorial disease of pandemic proportions, is associated with type 2 diabetes mellitus (T2DM), and both conditions share pathophysiological mechanisms. Adiposopathy promotes insulin resistance, mitochondrial dysfunction, and hyperinsulinemia; some patients develop T2DM as a comorbidity, which further exacerbates inflammation. We know that more than two-thirds of patients with T1DM are overweight (OW) and/or obese (OB), which leads to insulin resistance similar to that of T2DM.

Although the genetic and epigenetic burden of obesity must be taken into account in both types of T2DM, treatment is based on lifestyle changes that involve:

• Healthy eating, from a Mediterranean diet to disharmonious diets used for periods of time to achieve a greater metabolic impact.
• Appropriate physical activity for each person, ensuring aerobic and anaerobic exercise.
• Sleep management.
• Reducing stressors.
• Pharmacotherapy and/or metabolic surgery, depending on each case.

Glucagon-like polypeptide 1 receptor (GLP1RA) analogs and dual GLP1-GIP analogs promote therapeutic effects on appetite and satiety regulation in the nutrient-gut-brain axis. They also act on the pancreas, decreasing apoptosis, stimulating insulin release, and improving its secretion. In the case of the dual analog, they also stimulate glucagon secretion, resulting in improved glycemic control.

No GLP1RA currently available is approved for patients with T1DM. It is approved at different doses for the treatment of T2DM and/or obesity. There are publications on its use, and the risks and benefits of weight-loss treatments should be taken into account in people living with obesity associated with T1DM, whether with pharmacological approaches that are still off-label.

The treatment of obesity and T2DM is more widely studied and supported, both with drugs and surgical treatment. GLP-1RAs for the treatment of type 2 diabetes have been shown to be effective in promoting weight loss. This family of drugs promotes weight loss and improves hyperglycemia, insulin sensitivity, and blood pressure, providing cardio-renal-hepato-metabolic protection in addition to pleiotropic effects.

Special care should be taken regarding their indication, contraindications, and precautions for diabetic patients based on long-term follow-up studies.