More than 60% with Type 1 Diabetes Also Dealing with Overweight or Obesity, Study Finds

Michael Fang, MD, MHS

New research from the Johns Hopkins Bloomberg School of Public Health is underlining the need for weight management strategies in people with type 1 diabetes.¹

An analysis of data from the National Health Interview Survey over a half-decade period, results indicate 62% of adults with type 1 diabetes had overweight or obesity, which is similar to the 64% rate seen among the general population.¹

“The lack of evidence for safe, effective methods of diet- and exercise-based weight control in people with type 1 diabetes may be keeping doctors from recommending such methods,” says study first author Michael Fang, PhD, MHS, assistant professor in the Bloomberg School’s Department of Epidemiology.² “Large clinical trials have been done in type 2 diabetes patients to establish guidelines for diet- and exercise-based weight management, and we now need something similar for type 1 diabetes patients.”

The impact of the obesity epidemic on society and health systems has placed an immense burden on both, but this burden is only expected to grow.³ Although the association between obesity and overweight with type 2 diabetes is common knowledge and well-documented, much less research has detailed the contemporary prevalence between overweight and obesity among those with type 1 diabetes.

With this in mind, Fang and a team of colleagues from the Johns Hopkins Bloomberg School of Public Health designed their research endeavor as an analysis of data from the National Health Interview Survey cycles occurring between 2016-2021. From the 5 survey cycles, investigators obtained data related to 115,441 adults without diabetes, 733 with type 1 diabetes, and 12,397 with type 2 diabetes in their unweighted sample.

For the purpose of analysis, BMI was calculated using self-reported height and weight, with investigators defining BMI categories as less than 25 kg /m², 25 to less than 30 kg/m², and 30 kg/m² or more. Investigators pointed out survey weights were used to account for complex survey design and generate nationally representative estimates. Investigators also noted participants were asked to report whether their physicians had recommended lifestyle changes and whether they were engaged in those activities during survey cycles in 2016, 2017, and 2020.

Upon analysis, results indicate the prevalence of overweight or obesity in 2016-2021 was 64% among those without diabetes, 62% among those with type 1 diabetes, and 86% among those with type 2 diabetes. Among those with overweight or obesity, lifestyle recommendations from healthcare providers were more frequently received recommendations than those without diabetes but less frequently than those with type 2 diabetes. Further analysis demonstrated people with type 1 diabetes were less likely than those without diabetes or with type 2 diabetes to increase physical activity or reduce caloric intake in an effort to manage overweight or obesity.¹

“Our study busts the myth that people with type 1 diabetes are not being affected by the global obesity epidemic,“ said senior investigator Elizabeth Selvin, PhD, MPH, professor in the Bloomberg School’s Department of Epidemiology.² “These findings should be a wake-up call that we need to be aggressive in addressing the obesity epidemic in persons with type 1 diabetes.”

References

1. Fang M, Jeon Y, Echouffo-Tcheugui JB, Selvin E. Prevalence and management of obesity in U.S. adults with type 1 diabetes. Annals of Internal Medicine. 2023. doi:10.7326/m22-3078
2. Johns Hopkins Bloomberg School of Public Health. February 2023. https://publichealth.jhu.edu/2023/overweight-and-obesity-in-people-with-type-1-diabetes-nearly-same-as-general-population. Accessed February 14, 2023.
3. Campbell P. Study raises concerns over increasing BMI, obesity in preschool-aged children during pandemic. HCP Live. https://www.hcplive.com/view/study-raises-concerns-over-increasing-bmi-obesity-in-preschool-aged-children-during-pandemic. Published January 5, 2023. Accessed February 14, 2023.