Type 1 diabetes mellitus and obesity

Abstract

The phenotype of Type 1 diabetes (T1DM) was changing in recent years. There has been an alarming increase in the prevalence of overweight/obesity (O/O) in this patients. Although obesity has long been recognized as a major risk factor for the development of type 2 diabetes and a catalyst for complications, much less is known about the role of obesity in the initiation and pathogenesis of type 1 diabetes. Emerging evidence suggests that obesity contributes to insulin resistance, dyslipidemia, and cardiometabolic complications in type 1 diabetes. Unique therapeutic strategies may be required to address these comorbidities within the context of intensive insulin therapy, which promotes weight gain. There is an urgent need for clinical guidelines for the prevention and management of O/O in T1DM type 1. The development of these recommendations will require a transdisciplinary research strategy addressing metabolism, molecular mechanisms, lifestyle, neuropsychology, and novel therapeutics. The association of many new medications should be considered as a complementary treatment to insulin therapy like SGLT2 inhibitors, GLP-1 analogs, mineralocorticoid receptor blockers (fineronone) and Metformin. In certain patients the use of anti-obesity drugs like fentermine/topiramate (together or not) naltrexone/bupropion is indicated and even bariatric surgery. The goal or this presentacion is to provide a framework for the evidence base needed to develop type 1 diabetes–specific weight management recommendations that account for the competing outcomes of glycemic control and weight management.