Pathophysiology of overweight type 1 diabetic patients

Abstract

Although type 1 diabetes is traditionally considered a disease of lean people, overweight and obesity are becoming increasingly more common in individuals with type 1 diabetes. Non-physiological insulin replacement that causes peripheral hyperinsulinemia, insulin profiles that do not match basal and mealtime insulin needs, defensive snacking to avoid hypoglycemia, or a combination of these, are believed to affect body composition and drive excessive accumulation of body fat in people with type 1 diabetes. In spite of these causes, there are many others like genetic, epigenetic mechanisms and modifications of the microbioma that influence in the association of obesity and type 1 diabetes. The consequences of overweight or obesity in people with type 1 diabetes are of particular concern, as they increase the risk of both diabetes-related and obesity-related complications, including cardiovascular disease, stroke, various types of cancer and hepatic steatosis. We summarise the current understanding of the etiology and consequences of excessive bodyweight in people with type 1 diabetes and highlight the need to optimise future prevention and treatment strategies in this population.