Treatment of Morbid Obesity in Adults with Type 1 Diabetes

Adults with type 1 diabetes who also have obesity (BMI ≥30.0 kg/m², or ≥27.5 kg/m² in Asian American individuals) represent a clinically distinct population. Obesity management in this group draws on strategies used in the general adult population but requires a specifically adapted approach given the complexities of type 1 diabetes.

Clinical Scenario

Type 1 Diabetes Obesity BMI ≥30.0 kg/m² Asian American BMI ≥27.5 kg/m²

This protocol applies obesity management strategies — including pharmacological options used in the broader adult population — to adults with type 1 diabetes who meet the relevant BMI threshold.

Treatment Approach

The evidence-based approach centres on GLP-1 receptor agonist–based therapy, initiated after a detailed review of the drug's side-effect profile and a person-centred discussion of goals and expectations. Due to the specific metabolic context of type 1 diabetes, this therapy requires particularly cautious titration and close monitoring.

The complete protocol — including all monitoring requirements, dietary considerations, and the full management algorithm — is available via the link below.

Clinical Goals

Weight reduction with improvement in A1C and lower insulin requirements.

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References

DOI: 10.2337/dc26-S008

Apply obesity management strategies used in the general adult population, including GLP-1 RA–based therapy B and metabolic surgery, C 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.

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