Consequences of Weight Gain Associated With Insulin Therapy in Adolescents

Abstract

Abstract:Intensive insulin therapy is associated with the delayed onset and reduced risk of the development of microvascular complications in type 1 diabetes and is therefore recommended for most patients, including children and adolescents. Intensification of insulin therapy can be accompanied by increased weight gain, and fear of weight gain can represent a major barrier to adherence to intensive regimens. This is particularly true for adolescent girls who may have poor self-esteem and body image issues, and adopt behaviors such as insulin omission and disordered eating to prevent weight gain. Strategies to reduce insulin-associated weight gain include lifestyle interventions to improve nutritional intake and increase physical activity. The use of pharmacologic agents that minimize weight gain such as the inclusion of insulin detemir, agents that alter satiety and insulin sensitizers should also be considered and investigated further. In addition to understanding treatment strategies to limit insulin-related weight gain, the diabetes healthcare team should be aware of the early warning signs of disordered eating and insulin omission in the adolescent so that appropriate referral for psychologic intervention can occur.

Effects of exogenous human insulin dose adjustment on body mass index in adult patients with type 1 diabetes mellitus at Kalafong Hospital, Pretoria, South Africa, 2009 - 2014

“…According to this hypothesis, this conservation of ingested calories occurs when glycosuria is resolved with improved glycaemic control during IIT to blood glucose levels below the renal secretion threshold. [2] Where the results of this study may not be wholly consistent with those of other published studies on the topic, Nansel et al [10] advise that most differences of associations between studies can be attributed to differences in sample characteristics, study designs and statistical analytical methods. They also found the association between BMI and glycaemic control to be complex, highlighting the need for longitudinal study designs and appropriate analyses to account for the time-dependent direction of causation of the observed association.…”

“…The risk factors suggested by the review include oral glucose ingestion to offset hypoglycaemia, the fear of nocturnal hypoglycaemia resulting in night-time snacking, the anabolic effect of insulin on skeletal muscle mass, and alteration in the leptinmediated regulators of lipolysis and lipogenesis, [2] also resulting in resistance to the antilipolytic actions of insulin. [12] Conservation of calories in previously poorly controlled diabetic patients is hypothesised as another mechanism of weight gain in patients with type 1 DM.…”

“…In addition, anabolic effects of insulin on skeletal muscle, alterations in the regulators of adiposity, and the resolution of glycosuria leading to conservation of calories in previously poorly controlled patients with DM are also hypothesised as mechanisms of weight gain over time in type 1 DM. [2] Newer insulin formulations attempt to mimic physiological secretion of insulin by changing the onset and duration of action of insulin. However, these analogues are expensive and not available in the South African (SA) public health sector.…”

“…The current study also identified any insulin exposure adjusted for other covariates and baseline BMI to be significant predictors of weight gain in the cohort of patients observed. These findings are consistent with those of Conway et al[1] in a longitudinal study to determine the prevalence and incidence of overweight and obesity in a cohort of 589 type 1 DM patients followed up over at least 18 years.The Diabetes Control and Complications Trial cited in the review by Kaufman [2] also demonstrated the association between excess weight gain and IIT. The risk factors suggested by the review include oral glucose ingestion to offset hypoglycaemia, the fear of nocturnal hypoglycaemia resulting in night-time snacking, the anabolic effect of insulin on skeletal muscle mass, and alteration in the leptinmediated regulators of lipolysis and lipogenesis, [2] also resulting in resistance to the antilipolytic actions of insulin.…”