Overweight, obesity poorly managed in type 1 diabetes

U.S. adults with type 1 diabetes are about as likely to be overweight and obese as the general population but often don't receive guidance on weight management, a recent study found.

Researchers used data from five cycles of the National Health Interview Survey (2016, 2017, 2019, 2020, and 2021) to characterize the prevalence and management of overweight and obesity in U.S. adults with type 1 diabetes. History of diagnosed diabetes, diabetes type, and insulin use were self-reported. Body mass index (BMI) was calculated by using self-reported height and weight, and participants were classified as having normal weight (BMI <25 kg/m²), overweight (BMI of 25 to <30 kg/m²), or obesity (BMI ≥30 kg/m²). In three of the survey years (2016, 2017, and 2020), participants reported whether their physicians had recommended lifestyle changes, such as increasing physical activity or reducing consumption of calories or fat, during the previous year and whether they were currently implementing these measures. The results were published as a brief research report Feb. 14 by Annals of Internal Medicine.

Data from 128,571 nonpregnant adults were included in the study. Between 2016 and 2021, 64% of adults without diabetes, 62% of adults with type 1 diabetes, and 86% of adults with type 2 diabetes had overweight or obesity. Among adults with overweight or obesity, those with type 1 diabetes received lifestyle recommendations more frequently than those without diabetes but less frequently than those with type 2 diabetes; 54%, 43%, and 63% received recommendations to increase physical activity, and 52%, 41%, and 64% received recommendations to reduce fat or caloric intake, respectively. Those with type 1 diabetes were least likely of these three groups to manage overweight or obesity through lifestyle modification; 51%, 56%, and 53% said they were increasing their physical activity and 56%, 58%, and 64% said they were reducing their caloric or fat intake, respectively. Similar results were found after adjustment for age, sex, race or ethnicity, and survey year.

The researchers concluded that while U.S. adults with type 1 diabetes have rates of overweight and obesity that are virtually identical to those in the general adult population, only about half received recommendations about lifestyle recommendations from clinicians or implemented lifestyle changes. They noted that insulin use can complicate weight management in patients with type 1 diabetes, since changes to diet and exercise often require adjustments to dosage and timing to prevent hypoglycemia. “Among U.S. adults with type 1 diabetes, the burden of overweight and obesity is substantial and remains poorly managed,” the researchers concluded. “The development of more comprehensive clinical guidelines, with an emphasis on individualized patient education, may improve weight management in these patients.”