Obesity Linked To Type 1 Diabetes
Though being overweight is the main risk factor for developing type 2 diabetes, it has not previously been thought to be a major factor in type 1 diabetes, once known as "juvenile-onset diabetes." Type 1 diabetes is considered to be a genetically driven autoimmune disorder in which the body destroys the insulin-producing cells that allow it to process glucose. In type 2 diabetes, the body produces insulin but is unable to use it properly, a condition known as insulin resistance. In a hypothesis first made public two years ago, U.K. researcher Terry Wilkin, MD, and colleagues suggested that type 1 diabetes and type 2 diabetes are "one and the same disorder of insulin resistance set against different genetic backgrounds." To prove this, the researchers recently examined the relationship between body weight and age at diagnosis among a group of children with type 1 diabetes. Ninety-four children between the ages of 1 and 16 were included in the study, and a strong correlation was seen between the children's age at the time diabetes was diagnosed and their weight. The findings are published in the October issue of the American Diabetes Association journal Diabetes Care. "Basically, the age (at diagnosis) got younger and younger as the children got heavier and heavier," Wilkin tells WebMD. "This doesn't prove that insulin resistance drives type 1 diabetes, but it is some of the first direct evidence suggesting that it plays a role." Wilkins says the observation could explain why more and more children are developing type 1 diabetes and why they are doing so at earlier ages than ever before. Kids who develop type 1 diabetes are genetically predisposed to get the disease, but being overweight accelerates the process, he argues. Two other studies published in the same issue of Continue reading >>
Weight And Diabetes
A balanced diet and an active lifestyle can help all kids maintain a healthy weight. For kids with diabetes, diet and exercise are even more important because weight can affect diabetes and diabetes can affect weight. This is true for kids and teens with type 1 diabetes or type 2 diabetes. In diabetes, the body doesn't use glucose properly. Glucose, a sugar, is the main source of energy for the body. Glucose levels are controlled by a hormone called insulin , which is made in the pancreas. In type 1 diabetes , the pancreas does not make enough insulin. Undiagnosed or untreated type 1 diabetes can cause weight loss. Glucose builds up in the bloodstream if insulin isn't available to move it into the body's cells. When glucose levels become high, the kidneys work to get rid of unused sugar through urine (pee). This causes weight loss due to dehydration and loss of calories from the sugar that wasn't used as energy. Kids who develop type 1 diabetes often lose weight even though they have a normal or increased appetite. Once kids are diagnosed and treated for type 1 diabetes, weight usually returns to normal. Developing type 1 diabetes isn't related to being overweight, but keeping a healthy weight is important. Too much fat tissue can make it hard for insulin to work properly, leading to both higher insulin needs and trouble controlling blood sugar. In type 2 diabetes , the pancreas still makes insulin, but the insulin doesn't work in the body like it should and blood sugar levels get too high. Most kids and teens are overweight when they're diagnosed with type 2 diabetes. Being overweight or obese increases a person's risk for developing type 2 diabetes. Also, weight gain in people with type 2 diabetes makes blood sugar levels even harder to control. People with type 2 di Continue reading >>
Type 1 Diabetes In Adults
For years, distinguishing between the various types of diabetes was pretty straightforward: “Juvenile diabetes,” an autoimmune disease, was diagnosed primarily in children and teenagers when their own body’s immune system destroyed the insulin-producing (beta) cells in their pancreas. “Adult-onset diabetes” occurred in adults and was generally associated with insulin resistance and often with overweight. And “gestational diabetes” occurred in pregnant women and disappeared once the pregnancy was over. In the past 25 years, however, determining what type of diabetes a person has has become more of a challenge. In large part, that’s because more and more children and teenagers are now being diagnosed with Type 2 diabetes — the type that occurred predominantly in adults in generations past. Most of these children and teens are overweight. At the same time, it’s becoming clearer that Type 1 diabetes can occur at any age and sometimes occurs in people who are overweight. In addition, another type of diabetes, called latent autoimmune diabetes in adults, or LADA, that shares some characteristics with both Type 1 and Type 2 diabetes, has been recognized. Muddying the water further is the realization that diabetic ketoacidosis, an acute, life-threatening complication of diabetes that is caused by a lack of insulin, can occur in people with Type 2 diabetes — not just in people with Type 1, as was previously thought. And while gestational diabetes is still diagnosed only in pregnant women, it is sometimes discovered that what is thought to be gestational diabetes is really Type 1 or Type 2 diabetes that happens to start during pregnancy. The incidence of diabetes has increased so greatly around the world in the past 25 years that health organizations and med Continue reading >>
Obesity And Type 1 Diabetes
The summer before I was diagnosed with type 1 diabetes was the best summer of my life. For as long as I remember, I was both taller and bigger than most kids–including boys. I had dieted many times before, but that summer was magic. I was on the Ayds diet (small piece of Ayds candy with a cup of chicken broth 30 minutes before a meal), and for the first time in my vast 11 years of life, the diet was working: pounds melted away and I felt great about myself. People were complimenting me about how great I looked and how beautiful my legs were. I continued to melt away. My foray into the world of the svelte was fantastic! And then, I almost died. My beautiful, skeletal body betrayed me. The drastic weight loss came from my new forever friend: type 1 diabetes. The night of my diagnosis, a family friend, who was an R.N., gave me the words of encouragement I so desperately craved: “You will never have a weight problem again.” Un-truer words have never been spoken. The dietician gave me a high-calorie diet to put some weight back on my skeleton. I sadly complied. Of course it worked. Thus began the yo-yo dieting. By the time I was 14, I had lost and gained and lost and gained 75 pounds. It is easy for me to see how young girls fall prey to eating disorders. Girls with type 1 diabetes have an especially hard time because they have to be obsessed with insulin and food, and in the back of their minds they know that DKA is a fast ticket to weight loss. Diabulimia (diarexia) is the deliberate withholding of insulin to lose weight. Of course it works, but the consequences are disastrous (fatal, actually)…akin to gargling with chlorine bleach to whiten your teeth. I have girlfriends my age who have had type 1 diabetes for as long as I have, and they have been naturally thin a Continue reading >>
Type 1 Diabetes Is Not Associated With Increased Central Abdominal Obesity
Type 1 Diabetes Is Not Associated With Increased Central Abdominal Obesity Jerry R. Greenfield, MB, BS, BSC (MED), FRACP, Lesley V. Campbell, MB, BS, FRCP, FRACP and From the Diabetes and Obesity Research Program, Garvan Institute of Medical Research, Sydney, Australia Address correspondence to Professor Donald Chisholm, Diabetes and Obesity Research Program, Garvan Institute of Medical Research, 384 Victoria St., Darlinghurst NSW 2010, Sydney, Australia. E-mail: d.chisholm{at}garvan.org.au Diabetes Care 2003 Sep; 26(9): 2703-2703. We read with interest the recent editorial by Sobel ( 1 ), wherein it is asserted that intensive treatment of type 1 diabetes appears to increase central obesity. We agree with Sobel that the insulin resistance underlying type 2 diabetes and frequently manifested in those with type 1 diabetes may be the most powerful determinant of coronary disease ( 1 ), but argue that insulin resistance in type 1 diabetes is unrelated to increased central abdominal adiposity. Attention should be directed to our recent study ( 2 ), which examined the relationships between insulin sensitivity (glucose infusion rate [GIR] measured during euglycemic-hyperinsulinemic clamp), abdominal fat, lipid levels, blood pressure, and androgens in 10 premenopausal women with type 1 diabetes (HbA1c 8.1 1% and diabetes duration 24 10 years) and 10 nondiabetic BMI-matched control subjects. We found that GIR was lower in subjects with type 1 diabetes than in control subjects (49.3 14.8 vs. 73.2 21.6 mol min1 kg fat-free mass1 respectively, P = 0.01), indicating greater insulin resistance in the former ( 2 ). However, we found no difference between control and type 1 diabetic subjects in central abdominal adiposity (measured directly by dual-energy X-ray absorptiometry) and int Continue reading >>
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Weight Management In Patients With Type 1 Diabetes And Obesity
Go to: Introduction In the past 20 years, the prevalence of obesity has tripled worldwide, to the extent that it is now being considered an epidemic [1]. Obesity, defined as a body mass index (BMI) of ≥30 kg/m2, affects approximately 35% of men and 40% of women in the USA [2••]. It has recently been reported that obesity in particular is rising at a greater rate than overweight [3]. Though patients with type 1 diabetes (T1D) have traditionally been thought to have lower BMI, current research has shown otherwise [4]. The trend of increasing obesity prevalence has increased at a faster rate in patients with T1D compared to the general population [5]. Currently, around 50% of patients with T1D are either overweight or obese. They also have higher waist and hip circumferences when compared to healthy controls [4]. In the Pittsburgh Epidemiology of Diabetes Complications (EDC) Study, which followed adult patients with T1D for an average of 18 years, prevalence of overweight increased from 29 to 42% and prevalence of obesity increased sevenfold from 3 to 23% [5]. Weight gain appeared to be unrelated to aging and instead related to clinical factors such as insulin therapy [5]. Comorbidities, often associated with excess body weight, reduce the benefits of good metabolic control [6]. Thus, controlling body weight in patients with T1D is necessary due to the well-known relationship between obesity and cardiovascular disease (CVD) [7••]. Metabolic abnormalities related to obesity, such as the pro-inflammatory state, are likely to modify CVD risk in this population [7••]. So far, complications related to CVD have been the leading cause of mortality in patients with T1D [8]. In this review, we aim to describe the different mechanisms by which patients with T1D gain ex Continue reading >>
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Obesity In The Natural History Of Type 1 Diabetes Mellitus: Causes And Consequences
There has been a worldwide epidemic increasing in the prevalence of sedentary, overweight and obesity that comes with modernity and urbanization (Wang et al., 2002). The consequence is the development of insulin resistance (IR) and type 2 diabetes (T2D). This is classically defined as a metabolic disease that occurs due to a higher IR that leads to a slow setting of lower insulin production (more relative than absolute), in general in adult age. T2D is associated also with a genetic predisposition. The majority of T2D individuals are overweight or obese and the ones who do not, at least present increased abdominal adipose mass (ADA, 1997). The rising prevalence of overweight and obesity is happening also in children and adolescents (Pinhas-Hamiel et al., 1996; Willi & Egede, 2000; Rosenbloom et al., 1999). The metabolic syndrome (MS), which physiopathology is based on IR, shows the same trend in children and adolescents (Jago et al., 2008), as well as isolated pre-diabetes (Li In parallel, it has been seen an elevation in the number of type 1 diabetes (T1D) cases and its establishment at a younger age (EURODIAB ACE Study Group, 2000). T1D is characterized primarily by a pancreatic beta cell destruction, which may lead to ketosis. It can be classified beta antibodies) or idiopathic, in which no autoantibodies can be detected, and occurs more frequently in individuals of African-American or Asian origin. Multiple genetic predisposition and environmental factors are involved with T1D (ADA, 1997). At least one of those autoantibodies is present in 85-90% of T1D on diagnosis. The treatment for T1D consists of multiple insulin injections, known as intensive treatment, to obtain adequate macrovascular (Nathan et al., 2005 and 2003) chronic complications. However, it can be fol Continue reading >>
Obesity In Pregnancy May Up Risk Of Child With Type 1 Diabetes
Obesity in Pregnancy May Up Risk of Child With Type 1 Diabetes Women who were obese in the first trimester of pregnancy were 33% more likely to have a child with type 1 diabetes than pregnant mothers with normal body weight, as long as neither parent had any type of diabetes previously, a new study has found. But in this cohort of roughly 1.2 million children born in Sweden over a 14-year period, a child was still most likely to develop type 1 diabetes if either parent had type 1 diabetes, regardless of parental ethnicity, confirming that this is a highly heritable disease, say Dr Hozan I Hussen (Karolinska Institutet, Stockholm, Sweden) and colleagues in their paper published online April 27 in Diabetologia. The novel finding that maternal obesity in nondiabetic mothers confers an increased risk of type 1 diabetes has "important public-health implications," senior author Dr Tahereh Moradi (Karolinska Institutet, Stockholm, Sweden) told Medscape Medical News. The results suggest that strategies to reduce overweight and obesity before and during pregnancy could reduce the incidence of type 1 diabetes, which is currently increasing in children in most countries of the world. "Preventing high body mass index [BMI] during pregnancy [may help] prevent the offspring from developing type 1 diabetes," Dr Moradi observed. Asked to comment, Dr Nancy Butte (Baylor College of Medicine, Houston, Texas) said that "first and foremost, the study confirmed that heredity (paternal or maternal) for type 1 diabetes is the strongest risk factor for the development of type 1 diabetes in the offspring." Second, "high maternal BMI was associated with increased risk of type 1 diabetes in offspring of parents without diabetes, [and] this study newly explores the combined effect of both risk fac Continue reading >>
Bariatric Surgery In Obese Patients With Type 1 Diabetes
Abstract OBJECTIVE There is a paucity of data on the impact of bariatric surgery in type 1 diabetes (T1D). The aim of this review was to quantify the overall effects of bariatric surgery in obese patients with T1D. METHODS We searched PubMed, Scopus, ISI Web of Knowledge, and Google Scholar from their inception to December 2015 to identify all relevant studies of bariatric surgery in adult obese patients with T1D. RESULTS The review included 17 studies with 107 individuals, including 10 case series and 7 case reports. Overall, the dominant procedure was gastric bypass (n = 70; 65%). All studies reported a significant reduction in excess weight. A significant reduction in weight-adjusted daily insulin requirements was shown in all case series except one. Pooled mean ± SD of pre- and postoperative glycated hemoglobin (HbA1c) for the entire cohort with available data (n = 96) was 8.4 ± 1.3% and 7.9 ± 1.1%, respectively (P = 0.01). In addition to common postoperative complications, profound glycemic changes (diabetic ketoacidosis and hypoglycemia) and gastrointestinal dysmotility symptoms (prolonged ileus and acute gastric remnant dilation) have been reported. No surgical mortality was reported. CONCLUSIONS Bariatric surgery leads to significant weight loss in severely obese patients with T1D and results in a significant improvement in insulin requirements and glycemic status. The favorable metabolic effects of bariatric surgery may facilitate medical management of and cardiovascular risk reduction in T1D in the setting of severe obesity. Diabetic ketoacidosis and hypoglycemia are potentially serious complications. Short-term results of bariatric surgery in patients with T1D are encouraging, but larger and longer-term studies are needed. Introduction Patients with type 1 Continue reading >>
Childhood Obesity And Double Diabetes
Approximately 12.5 million children and adolescents in the United States are classified as obese. That’s 17 percent of people aged 2 to 19, according to the Center for Disease Control and Prevention (CDC). The number of children who are obese has almost tripled since 1980. Not only is the prevalence of obesity apparent in the general population of children and adolescents, but the pervasiveness of overweight and obesity is also evident within the pediatric diabetes population both in the U.S. and here at Joslin Diabetes Center. SEARCH, a national multi-center study of diabetes in youth, found that 22.1 percent of pediatric patients with type 1 diabetes are overweight and 12.6 percent are obese. Within the general pediatric population, 15 percent of children and adolescents are overweight and 17 percent are obese, according to a 2010 National Health and Nutrition Examination Survey (NHANES). Current childhood obesity rates make it more common for a patient with type 1 diabetes to present at diagnosis as overweight or obese, but for many years this was not the case. Before the rise of the obesity epidemic, people with type 1 diabetes were generally distinguished as being lean and thin, whereas people with type 2 diabetes were identified as commonly being overweight or obese. “Traditionally, it used to be the case that children at diagnosis were often underweight since they had lost weight substantial weight by the time they were diagnosed with type 1 diabetes,” said Charumathi Baskaran, M.D., Pediatric Research fellow at Joslin. “This was because as children develop diabetes, they do not produce enough insulin to use the carbohydrates in foods for energy. As a result, they start using up their fat stores for energy.” She continued, “despite the weight loss bef Continue reading >>
U.s. Youth With Type 1 Diabetes Overweight, But Obesity Epidemic Also Affecting European Youth
U.S. Youth with Type 1 Diabetes Overweight, but Obesity Epidemic Also Affecting European Youth U.S., Germany, and Austria pediatric type 1 diabetes population at increased risk for insulin resistance, cardiovascular disease; the downside of intensive insulin therapy BOSTON, July 8, 2015 – Adolescents with type 1 diabetes have not escaped the global obesity epidemic and those in the U.S. are significantly more overweight than their German and Austrian counterparts, according to a new study done by researchers from T1D Exchange. The findings are especially concerning as excessive weight puts adolescents with type 1 diabetes at higher risk for insulin resistance, severe hypoglycemia, and cardiovascular disease, which is the leading cause of death for type 1 diabetes patients. Researchers examined height and weight data of nearly 33,000 pediatric type 1 diabetes patients ages two through 18 via two massive databases: the T1D Exchange Clinic Registry, the most comprehensive type 1 diabetes database in the U.S., comprising more than 27,000 patients from 76 pediatric and adult endocrinology centers; and the Diabetes Prospective Follow-up (DPV) registry, a database with more than 40,000 patients from 209 centers in Germany and Austria. Nearly 40 percent of children in both registries were considered obese or overweight. However, children in the T1D Exchange Clinic Registry were more obese than those in the DPV (15 percent compared with 10 percent). The study, published online in The Journal of Pediatrics, is the first international comparison of body mass index (BMI) in pediatric type 1 diabetes patients. Historically, type 1 diabetes patients were often underweight because of ineffective methods of glucose control. However, the Diabetes Control and Complications Trial (DCCT) Continue reading >>
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Pediatric Type 1 Diabetes Linked To Excess Weight
SAN FRANCISCO, June 25 -- Children with type 1 diabetes are now more likely to be overweight than their nondiabetic peers, a dramatic difference from their thin, gaunt presentation of the past. The overall prevalence of overweight was 22.1% in type 1 diabetes patients ages 3 to 19 compared with 16.1% in those who did not have diabetes (P<0.05), Lenna L. Liu, MD, MPH, of Seattle Children's Hospital, and colleagues reported online in Pediatric Diabetes. But obesity rates were similar between type 1 diabetes and nondiabetic groups in the population-based study. "The really traditional teaching on type 1 diabetes was that children would present at diagnosis very thin and usually had lost a lot of weight," Dr. Liu said. "What's surprising is we're finding type 1 children who are overweight potentially early in their disease." Dr. Liu chalked up the change to societal shifts. "The childhood obesity epidemic is affecting children with diabetes as well, not just in type 2 diabetes." She cautioned, though, that the observational, cross-sectional data could not determine causality, including whether diabetes preceded the weight gain or whether weight gain was a result of treatment. Whatever the cause, the combination of diabetes and overweight or obesity in childhood portends poor outcomes later in life, Dr. Liu noted. "Their risk for cardiovascular disease, high blood pressure, and lipid abnormalities increases even more." She recommended integration of prevention efforts into care for pediatric type 1 diabetes, "and if they are already overweight or obese that that issue needs to be addressed in addition to management of their diabetes." Her group's SEARCH for Diabetes in Youth study included a population-based sample of 3,953 diabetic patients ages 3 to 19 for comparison with Continue reading >>
Obesity And Other Eating Problems When You Have Type 1 Diabetes
Obesity and other eating problems when you have type 1 diabetes Obesity and other eating problems when you have type 1 diabetes "When you are diabetic everything revolves around food" [Interview 29]. When young people were first diagnosed with type 1 diabetes, some were toldthey had to accept that they were no longer free to eat exactly when and what they fancied. Some may have been so young that they could accept having all decisions about food and eating made for them. For teenage diabetics the relationship to food can often be more difficult. Teenagers on fixed-dose regimestalked about how they minded having to take snacks between meals to fit in with their insulin routine and were sometimes self-conscious about their enforced healthy diet, which tended to exclude them from the freedom their friends seem to have over what they eat. For the most part young diabetics learn to deal with these difficulties and food does not take centre stage in their lives. But in a few cases young people find that their relationship with food dominates their lives and may develop into medical conditions such as clinical obesity, bulimia and anorexia . On this page, young people talk about their experiences of how their diabetes has been tied up with their eating problems. The young people we talked to said that in childhood they had 'well controlled' diabetes, but now, looking back, they realise the ways in which they felt different from their peers. They were on fixed dose regimes which meant theyhad to eat snacks at times when no one else did, particularly before PE; they found themselves unable to eat what other children ate at birthday parties, or they felt really upset when an insensitive teacher sent them to the toilet to do their insulin injections. Young women indicated that th Continue reading >>
Overweight And Obesity In Youth With Type 1 Diabetes
Go to: INTRODUCTION Globally, the incidence of type 1 diabetes (T1D) is increasing among youth, at an annual rate of 3%–4% per year, thus posing a significant public health problem (Bell et al., 2009; Lipman et al., 2013; Patterson et al., 2012). At the same time, the prevalence of overweight and obesity among all youth has increased precipitously over the past few decades (Wild, Roglic, Green, Sicree, & King, 2004) and has been deemed the major public health challenge facing youth in the 21st century (Jack, 2007). Surprisingly, overweight and obesity are now prevalent among youth with T1D, and a recent study demonstrated that youth with T1D are more likely to be overweight than their peers without the condition (Liu et al., 2010). Others have noted more than a twofold increase of overweight and obesity in youth with T1D since the 1990s when the Diabetes Control and Complications Trial (DCCT) availed the benefits of tight glucose control to reduce the complications of T1D (Libman, Pietropaolo, Arslanian, LaPorte, & Becker, 2003; Purnell et al., 1998). In the DCCT, a complication of intensive insulin therapy and tight glucose control was untoward weight gain, which was threefold higher in the intensive treatment group and was associated with more moderate to severe hypoglycemic events and better glucose control (American Diabetes Association, 1993; DCCT Research Group, 1988, 1993). Because excess weight is associated with increased risk for cardiovascular disease in youth without diabetes, excess weight in youth with T1D may contribute to a higher risk of cardiometabolic complications in these youth (Purnell et al., 2013; Van Vliet et al., 2012). Indeed, youth with T1D are predisposed to such complications by having diabetes, regardless of weight status (Krishnan & Sho Continue reading >>
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Young People With Type 1 Increasingly Likely To Be Obese, Experts Urge Dietary Changes
Young people with type 1 diabetes are increasingly likely to be obese, according to new research. The study, which was conducted by researchers from T1D Exchange, suggested that excessive consumption of processed foods was to blame, and urged people with type 1 diabetes to maintain a healthy diet and plenty of exercise. The study does not suggest that obesity is a cause. In fact a dramatic loss of weight is one of the key symptoms of type 1 diabetes. Rather the problem of weight gain and obesity can develop in some people with type 1 diabetes following their diagnosis. Traditionally, people with type 1 diabetes have tended to be underweight. This is because insulin and blood glucose management technologies were less advanced, and as a result, more glucose - and therefore calories - pass out of the body through the urine. However, as diabetes management has improved, more glucose and calories have been retained. Coupled with the same over-consumption of unhealthy foods that affects many people in society, it has meant that people with type 1 diabetes have been affected by the obesity crisis. Obesity in people with type 1 diabetes increases their risk of insulin resistance, severe hypoglycemia and cardiovascular disease. The research was conducted by examining the data of 33,000 pediatric diabetes patients aged to between two and 18, using their height and weight to judge their Body Mass Index (BMI.) Of those patients, nearly 40 per cent were classed as "overweight." The study, which was the first to compare data of young type 1 patients from a variety of countries, also found that higher BMI in people with type 1 diabetes was closely linked to higher HbA1c levels. The researchers blamed unhealthy diets for the rise in type 1 obesity, and urged young people to develop hea Continue reading >>
