Review Highlights Incretin Therapies for Obesity in Type 1 Diabetes Mellitus

The prevalence of overweight and obesity in individuals with Type 1 Diabetes Mellitus (T1DM) has significantly increased, driven by multifactorial causes including intensive insulin therapy, defensive carbohydrate intake, and adipose tissue dysfunction. This complicates management, creating a vicious cycle of weight gain and increased insulin dependence, and heightens risks for cardiovascular disease, nephropathy, retinopathy, and psychosocial burden. Current obesity treatments lack specific regulatory approval for T1DM, highlighting a critical therapeutic gap.

The authors conducted an evidence-based review to synthesize current knowledge on obesity in T1DM. They systematically examined the multifactorial causes, including treatment-related factors like intensive insulin therapy and behavioral aspects such as reduced physical activity due to fear of hypoglycemia. The review also explored pathophysiological mechanisms, such as adipose tissue dysfunction, and assessed the clinical implications of obesity in T1DM, including its association with various comorbidities. Finally, they evaluated current and emerging therapeutic approaches.

The review identified that obesity in T1DM is associated with increased risks of cardiovascular disease, nephropathy, retinopathy, and psychosocial burden. It highlighted that intensive insulin therapy and defensive carbohydrate intake contribute to weight gain, alongside pathophysiological mechanisms like adipose tissue dysfunction. This creates a vicious cycle of weight gain and increased insulin dependence in T1DM management. > Recent clinical studies demonstrate that incretin-based therapies, specifically glucagon-like peptide-1 (GLP-1) receptor agonists and dual GIP/GLP-1 agonists, can reduce body weight and insulin requirements in T1DM patients without significant safety concerns. Sodium-glucose cotransporter 2 (SGLT2) inhibitors also offer metabolic benefits but carry a risk of diabetic ketoacidosis. The review emphasized the critical lack of regulatory approval for obesity treatment agents specifically for T1DM.