Nearly Identical Rates of Overweight, Obesity Between Adults With T1D, General Population

Rates of overweight and obesity among US adults with type 1 diabetes (T1D) are virtually identical to rates in adults without diabetes, according to a study published in Annals of Internal Medicine. However, patients with T1D are less likely to receive lifestyle modification recommendations compared with patients with type 2 diabetes (T2D).

The study included 115,441 adults without diabetes, 12,397 adults with T2D, and 733 adults with T1D. Data was collected by the nationally representative National Health Interview Survey (NHIS) between 2016 and 2021.

The mean (SD) age was 46.6 (0.1) years in the no diabetes group, 49.2 (0.9) years in the T1D group, and 62.8 (0.2) years in the T2D group. Additionally, mean body mass index—measure by kg/m²—per group was 27.5 (0), 27.6 (0.3), and 30.9 (0.1), respectively. The ratio of male to female individuals was close to even in all groups. All groups were predominantly non-Hispanic White, followed by Hispanic, Black, Asian, and other race or ethnicity.

Between 2016 and 2021, data showed that 64% of adults without any type of diabetes had overweight or obesity, compared with 62% of adults with T1D and 86% with T2D. Data on overweight and obesity by diabetes status were unavailable in the 2018 NHIS, and T1D was defined as T1D diagnosis reported by the individual and current insulin use.

When broken down by category, rates of overweight were very similar across groups, with a crude rate of 36% in the no diabetes group and a crude rate of 34% for both the T1D and T2D groups. Adjusted prevalence of overweight slightly dropped from 34% to 30% in the T2D group only.

The rate of obesity was 28% for both the no diabetes group and the T1D group, and 52% for the T2D group. Prevalence of obesity per group remained the same in crude and adjusted percentages.

Among adults with overweight or obesity, those with T2D most frequently received lifestyle recommendations, followed by those with T1D, then those without diabetes. Regarding lifestyle changes, adults with T1D were least likely to increase physical activity or reduce their caloric intake in order to manage overweight or obesity. These results remained similar after adjusting for age, sex, race or ethnicity, and survey year.

“Nearly two thirds of U.S. adults with type 1 diabetes have overweight or obesity,” the authors wrote. “However, only about half of these patients received lifestyle recommendations from providers or engaged in lifestyle modification.”

However, adults without either type of diabetes were slightly more likely to increase their physical activity than either diabetes group, and adults with T2D were most likely to reduce their fat or caloric intake.

The authors noted self-reporting, limited sample size for adults with T1D, and lack of information on possible weight loss medication use as major limitations to the study. Due to the self-reporting aspect, there may have been potential misclassification of diabetes and weight status among participants.

“Among U.S. adults with type 1 diabetes, the burden of overweight and obesity is substantial and remains poorly managed,” the authors concluded. “The development of more comprehensive clinical guidelines, with an emphasis on individualized patient education, may improve weight management in these patients.”

Reference

Fang M, Jeon Y, Echouffo-Tcheugui JB, Selvin E. Prevalence and management of obesity in U.S. adults with type 1 diabetes. Ann Intern Med. Published online February 14, 2023. doi:10.7326/M22-3078