Each month, the OMA Pediatric Committee reviews a pediatric-focused obesity research update to help keep you up to date about the latest findings. This month’s update addresses pediatric obesity and diabetes.
Multi-Faceted Influence of Obesity on Type 1 Diabetes in Children – From Disease Pathogenesis to Complications
The rising prevalence of childhood obesity is not only associated with an increased risk for developing type 2 diabetes but also type 1 diabetes (T1D). However, the influence of obesity on this autoimmune disease is thought to be multifactorial and may further limit treatment options. This review describes the available evidence base and proposes new directions for the prevention and treatment of obesity-related T1D.
Over the years, childhood obesity has been closely linked to type 2 diabetes (T2D) and pathways to insulin resistance in numerous studies. The influence of obesity on type 1 diabetes (T1D) and other autoimmune diseases is likely multifactorial albeit not as well understood as other chronic diseases. Some of the factors include genetic and immunologic dysregulation leading to beta cell destruction. Likewise, obesity is also hypothesized to play a role in the development of T1D by triggering a chronic proinflammatory state. More recent emerging hypotheses also suggest that the gut microbiome may play a role in the development of diabetes and obesity through pathways such as gut absorption, permeability, and its immunogenicity. Previous studies have shown an association between the proportion and diversity of different gut microbiota with A1c and the eventual development of T1D in children.
At the intersection of T1D and obesity, there are several observations. To begin, it can be difficult to differentiate between types of diabetes due to overlapping features. As such, other clinical factors like birth and maternal histories should be considered in addition to lab data to help improve diagnostic accuracy. Moreover, concomitant obesity in T1D increases the risk of developing complications such as premature puberty, as well as accelerates complications associated with T1D such as cardiovascular disease. Finally, while daily insulin replacement therapy helps children with T1D achieve near-normal blood sugar levels, insulin may also play a role in weight gain, and thereby hasten weight gain in children already affected by obesity.
The lack of research on the interplay between T1D and obesity limits the awareness and understanding of pediatric clinicians. There are far fewer randomized control trials for T1D treatment and co-existing childhood obesity compared to type 2 diabetes. Interventions aimed at obesity prevention and management in children with T1D should be family-centered and include the four pillars of obesity treatment. Nonetheless, the authors identify several key differences in diabetes treatment that require further consideration when caring for children with obesity. Pharmacotherapy options are limited as most options available for use in type 2 diabetes are not studied or approved for use in T1D. In addition, after bariatric surgery patients with T1D and obesity experienced significant weight reduction, and improved blood pressure and lipid profile but did not see a significant improvement in glycemic control. Of the many studies included in the review, the study by Landau et al (2019) reiterated the need to pay special attention when patients with T1D and obesity consider bariatric surgery as 15% of patients developed diabetic ketoacidosis and of 23% acute hypoglycemic episodes in the postoperative period.
In sum, childhood obesity is a risk factor for type 1 diabetes and is associated with the earlier onset of diabetes in predisposed patients. This review provides a helpful summary of current hypotheses on the role of childhood obesity in the increasing prevalence of T1D and the acceleration of its complications, highlighting areas where ongoing research is needed.
Find more resources, curated by OMA’s Pediatric Committee, on our Pediatric Resources page. There you’ll find additional article reviews on various topics related to obesity as well as public resources for clinicians and families.