Treatment of Obesity in Individuals with Type 1 Diabetes

Authors

  • Mohammed Almehthel, MBBS, ABIM, CCD, FRCPC Division of Endocrinology, University of British Columbia, Vancouver, B.C. Obesity, Endocrinology and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia
  • Ali Alshehri, MD Obesity, Endocrinology and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia

DOI:

https://doi.org/10.58931/cdet.2024.2332

Abstract

The prevalence of obesity (OB) is increasing among individuals with type 1 diabetes (T1D), posing unique challenges for managing their blood sugar levels and long-term health. Unlike type 2 diabetes (T2D), which is closely linked to OB and insulin resistance (IR), addressing OB in T1D requires careful consideration, because patients rely on external insulin, which can contribute to weight gain. In this review, we will discuss the causes and complications of OB in individuals with T1D, current approaches to treatment, potential lifestyle, and medical, and surgical interventions to manage weight while effectively maintaining optimal blood sugar control.

Author Biographies

Mohammed Almehthel, MBBS, ABIM, CCD, FRCPC, Division of Endocrinology, University of British Columbia, Vancouver, B.C. Obesity, Endocrinology and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia

Dr. Almehthel is the Medical Director and Diabetes Technology Section Head at the Obesity, Endocrinology and Metabolism Center (OEMC) at King Fahad Medical City (KFMC). He is also an Associate Professor of Internal Medicine and Endocrinology at the University of British Columbia (UBC), Vancouver, Canada. Dr. Almehthel graduated from King Abdulaziz University Medical school and completed his postgraduate training in Internal Medicine and Endocrinology at BC in Vancouver, Canada where he earned his American Board and the Royal College of Physicians and Surgeons of Canada certifications in Internal Medicine and Endocrinology. He also completed a 2-year fellowship in Diabetes and Beta-cell Replacement Therapy for type one diabetes at UBC, Canada. He joined the OEMC at KFMC in October 2019 and served as the Diabetes Fellowship Program Director from January 2020 to December 2022 and Diabetes Department Chairperson from January 2021 to December 2022. Dr. Almehthel worked in many prestigious hospitals like King Faisal Specialist Hospital and  Research Center (KFSH & RC) where he served as a consultant endocrinologist and the Endocrinology Postgraduate Site Director at Vancouver General Hospital from 2011 to 2014. He also worked for Saint Paul’s Hospital and Vancouver General Hospital in Vancouver, Canada and was the Endocrinology Postgraduate Program Director at UBC from 2014 to 2019. Dr. Almehthel served as a member in many committees at the Saudi Commission for Health Specialities, Saudi FDA, Saudi Health Council, and Pharmacy and Therapeutics Committee at KFMC. Dr. Almehthel’s research and clinical interests are diabetes, beta-cell replacement therapy for type 1 diabetes, diabetes technology and adrenal disorders. He has authored and coauthored many peer reviewed abstracts, research papers and book chapters. He delivered many scientific talks nationally and internationally.

Ali Alshehri, MD, Obesity, Endocrinology and Metabolism Center, King Fahad Medical City, Riyadh, Saudi Arabia

Dr. Alshehri is the Vice president of Saudi Society for Study of Obesity, and the consultant and chairman of Obesity Medicine Department, (Obesity, Endocrine and Metabolism Center) at King Fahad Medical City, Riyadh, Saudi Arabia. He did his primary training in internal medicine and then he did his fellowship at department of adult endocrinology and metabolism, University of Ottawa, Canada, with sub speciality in obesity medicine. He's been involved in many of national and international events about obesity, speaking and leading discussions. His publications and research activities in the field are numerous including leading & running phase 3 clinical trials in Saudi Arabia. His research focuses mainly on the obesity burden in Saudi Arabia, the role of current and future obesity pharmacotherapy and post bariatric surgery care.

References

Van der Schueren B, Ellis D, Faradji RN, Al-Ozairi E, Rosen J, Mathieu C. Obesity in people living with type 1 diabetes. Lancet Diabetes Endocrinol. 2021;9(11):776-785. doi:10.1016/s2213-8587(21)00246-1

Fellinger P, Fuchs D, Wolf P, Heinze G, Luger A, Krebs M, et al. Overweight and obesity in type 1 diabetes equal those of the general population. Wien Klin Wochenschr. 2019;131(3-4):55-60. doi:10.1007/s00508-018-1434-9

Fang M, Echouffo-Tcheugui JB, Selvin E. Prevalence and management of obesity in U.S. adults with type 1 diabetes. Ann Intern Med. 2023;176(9):eL230228. doi:10.7326/l23-0228

Lalanne-Mistrih ML, Bonhoure A, Messier V, Boudreau V, Lebbar M, Talbo MK, et al. Overweight and obesity in people living with type 1 diabetes: a cross-sectional analysis of the BETTER Registry. Diabetes Metab Res Rev. 2024;40(6):e3837. doi:10.1002/dmrr.3837

Lavens A, Nobels F, De Block C, Oriot P, Verhaegen A, Chao S, et al. Effect of an integrated, multidisciplinary nationwide approach to type 1 diabetes care on metabolic outcomes: an observational real-world study. Diabetes Technol Ther. 2021;23(8):565-576. doi:10.1089/dia.2021.0003

Edqvist J, Rawshani A, Adiels M, Björck L, Lind M, Svensson AM, et al. BMI, Mortality, and cardiovascular outcomes in type 1 diabetes: findings against an obesity paradox. Diabetes Care. 2019;42(7):1297-1304. doi:10.2337/dc18-1446

Lee YB, Han K, Kim B, Jin SM, Lee SE, Jun JE, et al. High Proportion of adult cases and prevalence of metabolic syndrome in type 1 diabetes mellitus population in Korea: a nationwide study. Diabetes Metab J. 2019;43(1):76-89. doi:10.4093/dmj.2018.0048

Faradji-Hazán RN, Valenzuela-Lara M, Díaz-Barriga Menchaca AP, Almeda-Valdes P, Antonio-Villa NE, Vidrio-Velázquez M, et al. Type 1 diabetes care in Mexico: an analysis of the RENACED-DT1 National Registry. Rev Invest Clin. 2021;73(4):222-230. doi:10.24875/ric.20000498

Liu LL, Lawrence JM, Davis C, Liese AD, Pettitt DJ, Pihoker C, et al. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study. Pediatr Diabetes. 2010;11(1):4-11. doi:10.1111/j.1399-5448.2009.00519.x

Minges KE, Whittemore R, Weinzimer SA, Irwin ML, Redeker NS, Grey M. Correlates of overweight and obesity in 5529 adolescents with type 1 diabetes: The T1D Exchange Clinic Registry. Diabetes Res Clin Pract. 2017;126:68-78. doi:10.1016/j.diabres.2017.01.012

Maffeis C, Birkebaek NH, Konstantinova M, Schwandt A, Vazeou A, Casteels K, et al. Prevalence of underweight, overweight, and obesity in children and adolescents with type 1 diabetes: data from the international SWEET registry. Pediatr Diabetes. 2018;19(7):1211-1220. doi:10.1111/pedi.12730

Wilkin TJ. The accelerator hypothesis: a review of the evidence for insulin resistance as the basis for type I as well as type II diabetes. Int J Obes (Lond). 2009;33(7):716-726. doi:10.1038/ijo.2009.97

Wilkin TJ. The accelerator hypothesis: weight gain as the missing link between type i and type ii diabetes. Diabetologia. 2001;44(7):914-922. doi:10.1007/s001250100548

Luczyński W, Fendler W, Ramatowska A, Szypowska A, Szadkowska A, Młynarski W, et al. Polymorphism of the FTO gene influences body weight in children with type 1 diabetes without severe obesity. Int J Endocrinol. 2014;2014:630712. doi:10.1155/2014/630712

Purnell JQ, Dev RK, Steffes MW, Cleary PA, Palmer JP, Hirsch IB, et al. Relationship of family history of type 2 diabetes, hypoglycemia, and autoantibodies to weight gain and lipids with intensive and conventional therapy in the Diabetes Control and Complications Trial. Diabetes. 2003;52(10):2623-2629. doi:10.2337/diabetes.52.10.2623

Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986. doi:10.1056/nejm199309303291401

Russell-Jones D, Khan R. Insulin-associated weight gain in diabetes--causes, effects and coping strategies. Diabetes Obes Metab. 2007;9(6):799-812. doi:10.1111/j.1463-1326.2006.00686.x

Carlson MG, Campbell PJ. Intensive insulin therapy and weight gain in IDDM. Diabetes. 1993;42(12):1700-1707. doi:10.2337/diab.42.12.1700

Weight gain associated with intensive therapy in the diabetes control and complications trial. The DCCT Research Group. Diabetes Care. 1988;11(7):567-573. doi:10.2337/diacare.11.7.567

Russell-Jones DL, Rattray M, Wilson VJ, Jones RH, Sönksen PH, Thomas CR. Intraperitoneal insulin is more potent than subcutaneous insulin at restoring hepatic insulin-like growth factor-I mRNA levels in the diabetic rat: a functional role for the portal vascular link. J Mol Endocrinol. 1992;9(3):257-263. doi:10.1677/jme.0.0090257

Sönksen PH, Russell-Jones D, Jones RH. Growth hormone and diabetes mellitus. A review of sixty-three years of medical research and a glimpse into the future? Horm Res. 1993;40(1-3):68-79. doi:10.1159/000183770

De Keukelaere M, Fieuws S, Reynaert N, Vandoorne E, Kerckhove KV, Asscherickx W, et al. Evolution of body mass index in children with type 1 diabetes mellitus. Eur J Pediatr. 2018;177(11):1661-1666. doi:10.1007/s00431-018-3224-9

Burr JF, Shephard RJ, Riddell MC. Physical activity in type 1 diabetes mellitus: assessing risks for physical activity clearance and prescription. Can Fam Physician. 2012;58(5):533-535.

Taleb N, Haidar A, Messier V, Gingras V, Legault L, Rabasa-Lhoret R. Glucagon in artificial pancreas systems: potential benefits and safety profile of future chronic use. Diabetes Obes Metab. 2017;19(1):13-23. doi:10.1111/dom.12789

Matson RIB, Leary SD, Cooper AR, Thompson C, Narendran P, Andrews RC. Objective measurement of physical activity in adults with newly diagnosed type 1 diabetes and healthy individuals. Front Public Health. 2018;6:360. doi:10.3389/fpubh.2018.00360

Colberg SR, Laan R, Dassau E, Kerr D. Physical activity and type 1 diabetes: time for a rewire? J Diabetes Sci Technol. 2015;9(3):609-618. doi:10.1177/1932296814566231

Francescato MP, Stel G, Stenner E, Geat M. Prolonged exercise in type 1 diabetes: performance of a customizable algorithm to estimate the carbohydrate supplements to minimize glycemic imbalances. PLoS One. 2015;10(4):e0125220. doi:10.1371/journal.pone.0125220

Tielemans SM, Soedamah-Muthu SS, De Neve M, Toeller M, Chaturvedi N, Fuller JH, et al. Association of physical activity with all-cause mortality and incident and prevalent cardiovascular disease among patients with type 1 diabetes: the EURODIAB Prospective Complications Study. Diabetologia. 2013;56(1):82-91. doi:10.1007/s00125-012-2743-6

Teupe B, Bergis K. Epidemiological evidence for “double diabetes”. Lancet. 1991;337(8737):361-362. doi:10.1016/0140-6736(91)90988-2

Kilpatrick ES, Rigby AS, Atkin SL. Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: “double diabetes” in the Diabetes Control and Complications Trial. Diabetes Care. 2007;30(3):707-712. doi:10.2337/dc06-1982

Donga E, Dekkers OM, Corssmit EP, Romijn JA. Insulin resistance in patients with type 1 diabetes assessed by glucose clamp studies: systematic review and meta-analysis. Eur J Endocrinol. 2015;173(1):101-109. doi:10.1530/eje-14-0911

Chillarón JJ, Goday A, Flores-Le-Roux JA, Benaiges D, Carrera MJ, Puig J, et al. Estimated glucose disposal rate in assessment of the metabolic syndrome and microvascular complications in patients with type 1 diabetes. J Clin Endocrinol Metab. 2009;94(9):3530-3534. doi:10.1210/jc.2009-0960

Bjornstad P, Snell-Bergeon JK, Rewers M, Jalal D, Chonchol MB, Johnson RJ, et al. Early diabetic nephropathy: a complication of reduced insulin sensitivity in type 1 diabetes. Diabetes Care. 2013;36(11):3678-3683. doi:10.2337/dc13-0631

Schauer IE, Snell-Bergeon JK, Bergman BC, Maahs DM, Kretowski A, Eckel RH, et al. Insulin resistance, defective insulin-mediated fatty acid suppression, and coronary artery calcification in subjects with and without type 1 diabetes: The CACTI study. Diabetes. 2011;60(1):306-314. doi:10.2337/db10-0328

Secrest AM, Becker DJ, Kelsey SF, Laporte RE, Orchard TJ. Cause-specific mortality trends in a large population-based cohort with long-standing childhood-onset type 1 diabetes. Diabetes. 2010;59(12):3216-3222. doi:10.2337/db10-0862

Mottalib A, Tomah S, Hafida S, Elseaidy T, Kasetty M, Ashrafzadeh S, et al. Intensive multidisciplinary weight management in patients with type 1 diabetes and obesity: a one-year retrospective matched cohort study. Diabetes Obes Metab. 2019;21(1):37-42. doi:10.1111/dom.13478

Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American Association of Clinical Endocrinologists And American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22 Suppl 3:1-203. doi:10.4158/ep161365.Gl

Facilitating positive health behaviors and well-being to improve health outcomes: standards of care in diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S77-s110. doi:10.2337/dc24-S005

Ballesteros Pomar MD, Vilarrasa García N, Rubio Herrera M, Barahona MJ, Bueno M, Caixàs A, et al. The SEEN comprehensive clinical survey of adult obesity: executive summary. Endocrinol Diabetes Nutr (Engl Ed). 2021;68(2):130-136. doi:10.1016/j.endinu.2020.05.003

Children and adolescents: standards of care in diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S258-s281. doi:10.2337/dc24-S014

Scott SN, Anderson L, Morton JP, Wagenmakers AJM, Riddell MC. Carbohydrate restriction in type 1 diabetes: a realistic therapy for improved glycaemic control and athletic performance? Nutrients. 2019;11(5). doi:10.3390/nu11051022

Ranjan A, Schmidt S, Damm-Frydenberg C, Steineck I, Clausen TR, Holst JJ, et al. Low-carbohydrate diet impairs the effect of glucagon in the treatment of insulin-induced mild hypoglycemia: a randomized crossover study. Diabetes Care. 2017;40(1):132-135. doi:10.2337/dc16-1472

Chimen M, Kennedy A, Nirantharakumar K, Pang TT, Andrews R, Narendran P. What are the health benefits of physical activity in type 1 diabetes mellitus? A literature review. Diabetologia. 2012;55(3):542-551. doi:10.1007/s00125-011-2403-2

Fuchsjäger-Mayrl G, Pleiner J, Wiesinger GF, Sieder AE, Quittan M, Nuhr MJ, et al. Exercise training improves vascular endothelial function in patients with type 1 diabetes. Diabetes Care. 2002;25(10):1795-1801. doi:10.2337/diacare.25.10.1795

Brazeau AS, Rabasa-Lhoret R, Strychar I, Mircescu H. Barriers to physical activity among patients with type 1 diabetes. Diabetes Care. 2008;31(11):2108-2109. doi:10.2337/dc08-0720

Young V, Eiser C, Johnson B, Brierley S, Epton T, Elliott J, et al. Eating problems in adolescents with Type 1 diabetes: a systematic review with meta-analysis. Diabet Med. 2013;30(2):189-198. doi:10.1111/j.1464-5491.2012.03771.x

Lund SS, Tarnow L, Astrup AS, Hovind P, Jacobsen PK, Alibegovic AC, et al. Effect of adjunct metformin treatment in patients with type-1 diabetes and persistent inadequate glycaemic control. A randomized study. PLoS One. 2008;3(10):e3363. doi:10.1371/journal.pone.0003363

Petrie JR, Chaturvedi N, Ford I, Brouwers M, Greenlaw N, Tillin T, et al. Cardiovascular and metabolic effects of metformin in patients with type 1 diabetes (REMOVAL): a double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol. 2017;5(8):597-609. doi:10.1016/s2213-8587(17)30194-8

Gudzune KA, Kushner RF. Medications for obesity: a review. JAMA. 2024;332(7):571-584. doi:10.1001/jama.2024.10816

Tchang BG, Aras M, Kumar RB, Aronne LJ. Pharmacologic treatment of overweight and obesity in adults. In: Feingold KR, Anawalt B, Blackman MR, Boyce A, Chrousos G, Corpas E, et al., editors. Endotext. South Dartmouth (MA): MDText.com, Inc.Copyright © 2000-2024, MDText.com, Inc.; 2000.

Astra Zeneca Pharmaceuticals. L. Symlin® full prescribing information Wilmington DE, US: Astra Zeneca Pharmaceuticals; 2024. Available from: https://medicalinformation.astrazeneca-us.com/home/prescribing-information/symlin.html.

Edelman S, Garg S, Frias J, Maggs D, Wang Y, Zhang B, et al. A double-blind, placebo-controlled trial assessing pramlintide treatment in the setting of intensive insulin therapy in type 1 diabetes. Diabetes Care. 2006;29(10):2189-2195. doi:10.2337/dc06-0042

Ratner RE, Dickey R, Fineman M, Maggs DG, Shen L, Strobel SA, et al. Amylin replacement with pramlintide as an adjunct to insulin therapy improves long-term glycaemic and weight control in Type 1 diabetes mellitus: a 1-year, randomized controlled trial. Diabet Med. 2004;21(11):1204-1212. doi:10.1111/j.1464-5491.2004.01319.x

Rena G, Hardie DG, Pearson ER. The mechanisms of action of metformin. Diabetologia. 2017;60(9):1577-1585. doi:10.1007/s00125-017-4342-z

Jacobsen IB, Henriksen JE, Beck-Nielsen H. The effect of metformin in overweight patients with type 1 diabetes and poor metabolic control. Basic Clin Pharmacol Toxicol. 2009;105(3):145-149. doi:10.1111/j.1742-7843.2009.00380.x

Pörksen S, Nielsen LB, Kaas A, Kocova M, Chiarelli F, Orskov C, et al. Meal-stimulated glucagon release is associated with postprandial blood glucose level and does not interfere with glycemic control in children and adolescents with new-onset type 1 diabetes. J Clin Endocrinol Metab. 2007;92(8):2910-2916. doi:10.1210/jc.2007-0244

Griffin KJ, Thompson PA, Gottschalk M, Kyllo JH, Rabinovitch A. Combination therapy with sitagliptin and lansoprazole in patients with recent-onset type 1 diabetes (REPAIR-T1D): 12-month results of a multicentre, randomised, placebo-controlled, phase 2 trial. Lancet Diabetes Endocrinol. 2014;2(9):710-718. doi:10.1016/s2213-8587(14)70115-9

Ellis SL, Moser EG, Snell-Bergeon JK, Rodionova AS, Hazenfield RM, Garg SK. Effect of sitagliptin on glucose control in adult patients with Type 1 diabetes: a pilot, double-blind, randomized, crossover trial. Diabet Med. 2011;28(10):1176-1181. doi:10.1111/j.1464-5491.2011.03331.x

Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S158-s178. doi:10.2337/dc24-S009

Park J, Ntelis S, Yunasan E, Downton KD, Yip TC, Munir KM, et al. Glucagon-like peptide 1 analogues as adjunctive therapy for patients with type 1 diabetes: an updated systematic review and meta-analysis. J Clin Endocrinol Metab. 2023;109(1):279-292. doi:10.1210/clinem/dgad471

Garg SK, Kaur G, Haider Z, Rodriquez E, Beatson C, Snell-Bergeon J. Efficacy of Semaglutide in overweight and obese patients with type 1 diabetes. Diabetes Technol Ther. 2024;26(3):184-189. doi:10.1089/dia.2023.0490

Grassi BA, Teresa Onetto M, Sánchez C, Tapia N, Mena F. Effect of low dose Semaglutide in people with type 1 diabetes and excess weight. Diabetes Res Clin Pract. 2024;209:111593. doi:10.1016/j.diabres.2024.111593

Mertens J, De Winter HT, Mazlom H, Peiffer Fw, Dirinck EL, Bochanen N, et al. 751-P: Effect of once-weekly semaglutide on weight change and metabolic control in people with type 1 diabetes—six-months results from the Real-World STEMT Trial. Diabetes. 2022;71(Supplement_1). doi:10.2337/db22-751-P

Habeeb K, Brema I, Almehthel M, Alshehri A. 810-P: Role of glucagon-like-peptide-1 agonists as an adjunctive treatment in adults with type 1 diabetes mellitus and overweight/obesity, retrospective cohort, Saudi Arabia 2023. Diabetes. 2024;73(Supplement_1). doi:10.2337/db24-810-P

Akturk HK, Dong F, Snell-Bergeon JK, Karakus KE, Shah VN. Efficacy and safety of tirzepatide in adults with type 1 diabetes: a proof of concept observational study. J Diabetes Sci Technol. 2024:19322968231223991. doi:10.1177/19322968231223991

Garg SK, Akturk HK, Kaur G, Beatson C, Snell-Bergeon J. Efficacy and safety of tirzepatide in overweight and obese adult patients with type 1 diabetes. Diabetes Technol Ther. 2024;26(6):367-374. doi:10.1089/dia.2024.0050

Dandona P, Mathieu C, Phillip M, Hansen L, Tschöpe D, Thorén F, et al. Efficacy and safety of dapagliflozin in patients with inadequately controlled type 1 diabetes: The DEPICT-1 52-week study. Diabetes Care. 2018;41(12):2552-2559. doi:10.2337/dc18-1087

Mathieu C, Dandona P, Gillard P, Senior P, Hasslacher C, Araki E, et al. Efficacy and safety of dapagliflozin in patients with inadequately controlled type 1 diabetes (the DEPICT-2 Study): 24-week results from a randomized controlled trial. Diabetes Care. 2018;41(9):1938-1946. doi:10.2337/dc18-0623

Pieber TR, Famulla S, Eilbracht J, Cescutti J, Soleymanlou N, Johansen OE, et al. Empagliflozin as adjunct to insulin in patients with type 1 diabetes: a 4-week, randomized, placebo-controlled trial (EASE-1). Diabetes Obes Metab. 2015;17(10):928-935. doi:10.1111/dom.12494

Rosenstock J, Marquard J, Laffel LM, Neubacher D, Kaspers S, Cherney DZ, et al. Empagliflozin as adjunctive to insulin therapy in type 1 diabetes: The EASE trials. Diabetes Care. 2018;41(12):2560-2569. doi:10.2337/dc18-1749

Buse JB, Garg SK, Rosenstock J, Bailey TS, Banks P, Bode BW, et al. Sotagliflozin in combination with optimized insulin therapy in adults with type 1 diabetes: the North American inTandem1 Study. Diabetes Care. 2018;41(9):1970-1980. doi:10.2337/dc18-0343

Danne T, Cariou B, Banks P, Brandle M, Brath H, Franek E, et al. HbA(1c) and hypoglycemia reductions at 24 and 52 weeks with sotagliflozin in combination with insulin in adults with type 1 diabetes: the European inTandem2 Study. Diabetes Care. 2018;41(9):1981-1990. doi:10.2337/dc18-0342

Garg SK, Henry RR, Banks P, Buse JB, Davies MJ, Fulcher GR, et al. Effects of sotagliflozin added to insulin in patients with type 1 diabetes. N Engl J Med. 2017;377(24):2337-2348. doi:10.1056/NEJMoa1708337

Mahase E. Type 1 diabetes drug was withdrawn because of a “commercial conflict of interest,” charity argues. BMJ. 2022;376:o373. doi:10.1136/bmj.o373

Höskuldsdóttir G, Ekelund J, Miftaraj M, Wallenius V, Ottosson J, Näslund I, et al. Potential benefits and harms of gastric bypass surgery in obese individuals with type 1 diabetes: a nationwide, matched, observational cohort study. Diabetes Care. 2020;43(12):3079-3085. doi:10.2337/dc20-0388

Parmar C, Appel S, Lee L, Ribeiro R, Sakran N, Pouwels S. Choice of bariatric surgery in patients with obesity and type 1 diabetes mellitus? An up-to-date systematic review. Obes Surg. 2022;32(12):3992-4006. doi:10.1007/s11695-022-06321-4

Downloads

Published

2024-11-25

How to Cite

Almehthel, M., & Alshehri, A. (2024). Treatment of Obesity in Individuals with Type 1 Diabetes. Canadian Diabetes & Endocrinology Today, 2(3), 22–32. https://doi.org/10.58931/cdet.2024.2332

Issue

Volume 2, Issue 3, Fall 2024

Section

Articles

License

Copyright (c) 2024 Canadian Diabetes & Endocrinology Today

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.