Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges

Nuria Vilarrasa,1,2 Patricia San Jose,1 Miguel Ángel Rubio,3 Albert Lecube2,4,5 1Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain; 2CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos...

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Autores principales:	Vilarrasa N, San Jose P, Rubio MA, Lecube A
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	obesity type 1 diabetes dual diabetes insulin resistance metabolic syndrome bariatric surgery Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/77eca8d3e48c4859b8c51bc8ae8c1ef6
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spelling	oai:doaj.org-article:77eca8d3e48c4859b8c51bc8ae8c1ef62021-12-02T17:46:27ZObesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges1178-7007https://doaj.org/article/77eca8d3e48c4859b8c51bc8ae8c1ef62021-06-01T00:00:00Zhttps://www.dovepress.com/obesity-in-patients-with-type-1-diabetes-links-risks-and-management-ch-peer-reviewed-fulltext-article-DMSOhttps://doaj.org/toc/1178-7007Nuria Vilarrasa,1,2 Patricia San Jose,1 Miguel Ángel Rubio,3 Albert Lecube2,4,5 1Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain; 2CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain; 3Department of Endocrinology & Nutrition, Hospital Clínico San Carlos, IDISSC, Madrid, 28040, Spain; 4Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Lleida, 25198, Spain; 5Obesity, Diabetes and Metabolism (ODIM) Research Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), University of Lleida, Lleida, SpainCorrespondence: Nuria VilarrasaHospital Universitario de Bellvitge-IDIBELL, C/Feixa Llarga s/n, 08907 L´Hospitalet de Llobregat, Barcelona, SpainTel +34 93-5338511Fax +34 933375248Email nuriavilarrasa@yahoo.esAbstract: Obesity affects large numbers of patients with type 1 diabetes (T1D) across their lifetime, with rates ranging between 2.8% and 37.1%. Patients with T1D and obesity are characterized by the presence of insulin resistance, of high insulin requirements, have a greater cardiometabolic risk and an enhanced risk of developing chronic complications when compared to normal-weight persons with T1D. Dual treatment of obesity and T1D is challenging and no specific guidelines for improving outcomes of both glycemic control and weight management have been established for this population. Nevertheless, although evidence is scarce, a comprehensive approach based on a balanced hypocaloric diet, physical activity and cognitive behavioral therapy by a multidisciplinary team, expert in both obesity and diabetes, remains as the best clinical practice. However, weight loss responses with lifestyle changes alone are limited, so in the “roadmap” of the treatment of obesity in T1D, it will be helpful to include anti-obesity pharmacotherapy despite at present there is a lack of evidence since T1D patients have been excluded from anti-obesity drug clinical trials. In case of severe obesity, bariatric surgery has proven to be of benefit in obtaining a substantial and long-term weight loss and reduction in cardiovascular risk. The near future looks promising with the development of new and more effective anti-obesity treatments and strategies to improve insulin resistance and oxidative stress. Advances in precision medicine may help individualize and optimize the medical management and care of these patients. This review, by gathering current evidence, highlights the need of solid knowledge in all facets of the treatment of patients with obesity and T1D that can only be obtained through high quality well-designed studies.Keywords: obesity, type 1 diabetes, dual diabetes, insulin resistance, metabolic syndrome, bariatric surgeryVilarrasa NSan Jose PRubio MALecube ADove Medical Pressarticleobesitytype 1 diabetesdual diabetesinsulin resistancemetabolic syndromebariatric surgerySpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 14, Pp 2807-2827 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	obesity type 1 diabetes dual diabetes insulin resistance metabolic syndrome bariatric surgery Specialties of internal medicine RC581-951
spellingShingle	obesity type 1 diabetes dual diabetes insulin resistance metabolic syndrome bariatric surgery Specialties of internal medicine RC581-951 Vilarrasa N San Jose P Rubio MA Lecube A Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges
description	Nuria Vilarrasa,1,2 Patricia San Jose,1 Miguel Ángel Rubio,3 Albert Lecube2,4,5 1Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain; 2CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain; 3Department of Endocrinology & Nutrition, Hospital Clínico San Carlos, IDISSC, Madrid, 28040, Spain; 4Endocrinology and Nutrition Department, Hospital Universitari Arnau de Vilanova, Lleida, 25198, Spain; 5Obesity, Diabetes and Metabolism (ODIM) Research Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), University of Lleida, Lleida, SpainCorrespondence: Nuria VilarrasaHospital Universitario de Bellvitge-IDIBELL, C/Feixa Llarga s/n, 08907 L´Hospitalet de Llobregat, Barcelona, SpainTel +34 93-5338511Fax +34 933375248Email nuriavilarrasa@yahoo.esAbstract: Obesity affects large numbers of patients with type 1 diabetes (T1D) across their lifetime, with rates ranging between 2.8% and 37.1%. Patients with T1D and obesity are characterized by the presence of insulin resistance, of high insulin requirements, have a greater cardiometabolic risk and an enhanced risk of developing chronic complications when compared to normal-weight persons with T1D. Dual treatment of obesity and T1D is challenging and no specific guidelines for improving outcomes of both glycemic control and weight management have been established for this population. Nevertheless, although evidence is scarce, a comprehensive approach based on a balanced hypocaloric diet, physical activity and cognitive behavioral therapy by a multidisciplinary team, expert in both obesity and diabetes, remains as the best clinical practice. However, weight loss responses with lifestyle changes alone are limited, so in the “roadmap” of the treatment of obesity in T1D, it will be helpful to include anti-obesity pharmacotherapy despite at present there is a lack of evidence since T1D patients have been excluded from anti-obesity drug clinical trials. In case of severe obesity, bariatric surgery has proven to be of benefit in obtaining a substantial and long-term weight loss and reduction in cardiovascular risk. The near future looks promising with the development of new and more effective anti-obesity treatments and strategies to improve insulin resistance and oxidative stress. Advances in precision medicine may help individualize and optimize the medical management and care of these patients. This review, by gathering current evidence, highlights the need of solid knowledge in all facets of the treatment of patients with obesity and T1D that can only be obtained through high quality well-designed studies.Keywords: obesity, type 1 diabetes, dual diabetes, insulin resistance, metabolic syndrome, bariatric surgery
format	article
author	Vilarrasa N San Jose P Rubio MA Lecube A
author_facet	Vilarrasa N San Jose P Rubio MA Lecube A
author_sort	Vilarrasa N
title	Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges
title_short	Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges
title_full	Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges
title_fullStr	Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges
title_full_unstemmed	Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges
title_sort	obesity in patients with type 1 diabetes: links, risks and management challenges
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/77eca8d3e48c4859b8c51bc8ae8c1ef6
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_version_	1718379536237723648

Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges

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