The association between overweight/obesity and double diabetes in adults with type 1 diabetes; a cross-sectional study

Abstract

Background Double Diabetes (DD), type 1 diabetes (T1DM) + insulin resistance (IR), is associated with increased risk of micro/macro-vascular complications and mortality. Obesity can contribute to the development of DD. This study explored the prevalence of overweight/obesity and their association with DD in adults with T1DM. Methods Cross-sectional study of consecutive adults with T1DM attending diabetes clinics in a secondary care hospital (January-November 2019). Estimated glucose disposal rate (eGDR) was used as a marker of IR, and an eGDR < 8 was used to identify individuals with DD. Results One hundred seven adults with T1DM were included; female/male: 51/56; age [median (inter-quartile range): 30.0 (23–51) years]; BMI 25.4 (22.8–30.0) kg/m2. Overweight/obesity prevalence was 57/107 (53.3 %) [overweight: 30/107 (28 %); obesity: 27/107 (25.2 %)]. Compared to those with normal BMI, individuals with T1DM and overweight/obesity had longer diabetes duration; higher total daily insulin dose; and higher DD prevalence: 48/57 (84.2 %) vs. 14/50 (28 %) (p < 0.01); with similar HbA1c. BMI correlated with total daily insulin dose (rho = 0.55; p < 0.01). Individuals with DD were older, had longer duration of diabetes, higher HbA1c, and more adverse lipid profile and microalbuminuria compared to those without DD. Conclusions Overweight/obesity is very common in adults with T1DM, and is associated with double diabetes. BMI is positively associated with total insulin dose. Double diabetes is associated with adverse cardiovascular risk profile and is also common in lean individuals with T1DM. Further research is needed to examine the impact of overweight/obesity in people with T1DM and whether weight loss in this population can improve diabetes-related outcomes.

Prevalence of overweight/obesity and its relationship with metabolic syndrome and fatty liver index in adult patients with type 1 diabetes. A Brazilian multicenter study

“…Our data did not show an association between overweight/obesity with HbA1c levels or with the number of patients that reached the targets for good glycemic control, similar to data found in another study [ 39 ], in which patients with overweight/obesity used higher daily insulin doses compared to patients without overweight/obesity, but also with no difference in HbA1c levels.…”

“…Controversial results have been described in patients with T1D with overweight/obesity concerning glycemic control [ 8 , 39 ]. The DCCT showed that independent of the weight gain, patients under intensive insulin treatment achieved the same HbA1c levels during the follow-up [ 8 ].…”

The impact of obesity: a narrative review

“…There is also increasing evidence for the role of obesity in the increased incidence of type 1 diabetes mellitus (T1DM), with studies from North America and the UK suggesting an increasing prevalence of overweight and obesity in people with T1DM. [ 24 ] It has been hypothesised that obesity-induced insulin resistance may be responsible for the accelerated loss of pancreatic β cells through excessive stimulation[ 25 ] and a chronic proinflammatory state. [ 26 ] This causal role is supported by MR studies, although the evidence is not as consistent (compared to obesity and T2DM), with high heterogeneity between the studies.…”

Manchester Intermittent and Daily diet Type 1 Diabetes App Study (MIDDAS-Type 1): protocol for a randomised feasibility trial of an intermittent and continuous low-energy diet in patients with type 1 diabetes and overweight and obesity

“…There are approximately 400 000 people with type 1 diabetes (T1D) in the United Kingdom, with rates increasing by 4% annually 1. T1D is associated with a healthy bodyweight; however, overweight and obesity is becoming increasingly common in this population due, in part, to modern more intensive approaches to manage hyperglycaemia with higher daily doses of insulin, as evidenced by the Diabetes Control and Complications Trial, and other studies 2 3. The prevalence of obesity (body mass index (BMI) ≥30 kg/m 2 ) in adults with T1D from the Pittsburgh Epidemiology of Diabetes Complications Study increased from 3.4% at baseline (1986–1988) to 22.7% (2004–2007) 4.…”