Treatment of Drug-induced Obesity in Type 1 Diabetes with BMI ≥30.0 kg/m²
Adults with type 1 diabetes who develop obesity present a distinct management challenge: effective weight reduction must be pursued while accounting for active insulin therapy, glycaemic variability, and the attendant risk of hypoglycaemia.
Clinical scenario
This protocol applies to adults with type 1 diabetes who have obesity defined as BMI ≥30.0 kg/m² (or ≥27.5 kg/m² in Asian American individuals). The same obesity management strategies used in the general adult population — including receptor agonist–based pharmacotherapy and metabolic surgery — are applicable in this population.
Treatment approach — partial overview
The protocol centres on initiation of GLP-1 receptor agonist–based therapy, or a dual receptor agonist approach. Given the specific considerations in type 1 diabetes, the protocol places particular emphasis on cautious dose titration and close monitoring of insulin requirements and hypoglycaemia frequency.
Agent selection rationale, complete titration algorithm, and monitoring framework are available in the full protocol below.
References
DOI: 10.2337/dc26-S008
Apply obesity management strategies used in the general adult population, including GLP-1 RA–based therapy and metabolic surgery, to adults with type 1 diabetes who have obesity (BMI ≥30.0 kg/m², or ≥27.5 kg/m² in Asian American individuals).
For treatment of obesity in people with type 1 diabetes, initiation of GLP-1 RA or dual GIP and GLP-1 RA should follow a detailed review of the drug side effect profiles and a person-centered dialogue about goals and expectations.
In the absence of robust data specific to people with type 1 diabetes, titration of GLP-1 RA–based therapy should be particularly cautious and accompanied by close monitoring of changes in insulin requirements and in the frequency of episodes of hypoglycemia.
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