Treatment of Unspecified Obesity in Type 1 Diabetes
Clinical scenario
This protocol applies to adults with Type 1 diabetes who have comorbid obesity, defined as a BMI ≥30.0 kg/m², or ≥27.5 kg/m² in Asian American individuals. The presence of insulin-dependent diabetes alongside obesity creates specific treatment considerations that go beyond standard obesity management.
Treatment approach
Obesity management strategies from the general adult population can be applied in this setting, including GLP-1 receptor agonist–based therapy. Initiation requires a detailed review of drug side-effect profiles and a person-centred dialogue about goals and expectations — with particular emphasis on safe, cautious titration. The full protocol outlines the specific steps, monitoring requirements, and counselling points that must accompany this approach in people with Type 1 diabetes.
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.
- Dose escalation protocols validated in people with type 2 diabetes should not be extrapolated to people with type 1 diabetes, for whom 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.
- It is essential to counsel people with type 1 diabetes who start treatment with a GLP-1 RA or a dual GIP and GLP-1 RA on anticipating an increased risk of hypoglycemia and a reduction in insulin requirements, on maintaining a critical carbohydrate intake, and on testing for excess ketone body production.
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