Changes in weight and body composition after initiating insulin therapy and their relationship with metabolic control during the first year of type 1 diabetes in adults. InLipoDiab1 Study
Keywords:diabetes mellitus type 1, weight change, body composition, insulin therapy, HbA1c, lipid profile
Introduction. As in the general population, an increase in the incidence of overweight has been observed in individuals with type 1 diabetes (T1DM). Nevertheless, weight gain in this group may contribute to the deterioration of the metabolic management. The aim of this study was to evaluate changes in the body weight and body composition after initiating insulin therapy and to assess their relationship with the metabolic management during the first year of T1DM in adults.
Material and Methods. The prospective analysis included 139 adults patients with newly diagnosed T1DM, treated with Intensive functional insulin therapy (IFI) from the onset of the disease (age 26.3 ± 5.9 years). Patients were assessed at the time of the diagnosis and after 12 months. Metabolic parameters, including the HbA1c and lipid profile were investigated. The group was divided according to weight gain during the follow-up period.
Results. Weight gain was observed in 68.3% of participants (n = 95). In most cases an increase in body fat was found (41% vs 59% p = 0.01). Changes in the body weight corresponded to significant changes in body composition. Conversely, HbA1c decreased during the follow-up in all groups. The highest reduction was observed in a group with “excessive weight gain”. Additionally, a significant increase in high density lipoproteins was observed in each group. However, weight gain was not accompanied by a deterioration of the lipid profile.
Conclusions. Weight gain is a considerable problem among adults with newly diagnosed T1DM and is connected mainly with an increase of adipose tissue above the normal range. Changes in the body weight, associated with body composition changes, did not result in the dysfunctions of the metabolic management.
Miyazawa I, Kadota A, Miura K, Okamoto M, Nakamura T, Ikai T, Maegawa H, Ohnishi A. Twelve-year trends of increasing overweight and obesity in patients with diabetes: the Shiga Diabetes Clinical Survey. Endocr J. 2018 May 28;65(5):527-536. doi: 10.1507/endocrj.EJ17-0415. Epub 2018 Mar 10. Erratum in: Endocr J. 2021;68(2):251. PMID: 29526989.
Purnell JQ, Hokanson JE, Marcovina SM, Steffes MW, Cleary PA, Brunzell JD. Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: results from the DCCT. Diabetes Control and Complications Trial. JAMA. 1998 Jul 8;280(2):140-6. doi: 10.1001/jama.280.2.140. Erratum in: JAMA 1998 Nov 4;280(17):1484. PMID: 9669786; PMCID: PMC2622729.
Purnell JQ, Braffett BH, Zinman B, Gubitosi-Klug RA, Sivitz W, Bantle JP, Ziegler G, Cleary PA, Brunzell JD; DCCT/EDIC Research Group. Impact of Excessive Weight Gain on Cardiovascular Outcomes in Type 1 Diabetes: Results From the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study. Diabetes Care. 2017 Dec;40(12):1756-1762. doi: 10.2337/dc16-2523. PMID: 29138273; PMCID: PMC5711332.
Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, Cleary P, Crofford O, Davis M, Rand L, Siebert C. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 Sep 30;329(14):977-86. doi: 10.1056/NEJM199309303291401. PMID: 8366922.
Adverse events and their association with treatment regimens in the diabetes control and complications trial. Diabetes Care. 1995 Nov;18(11):1415-27. doi: 10.2337/diacare.18.11.1415. PMID: 8722064.
Cieluch A, Uruska A, Grzelka-Woźniak A, Niedźwiecki P, Flotyńska J, Zozulińska-Ziółkiewicz D. Changes in high-density lipoprotein cholesterol (HDL-C) level and the ratio of triglycerides to HDL-C during the first year of type 1 diabetes. Pol Arch Intern Med. 2019 Sep 30;129(9):598-604. doi: 10.20452/pamw.14920. Epub 2019 Aug 5. PMID: 31379357.
Horne JR, Gilliland JA, O'Connor CP, Seabrook JA, Madill J. Change in Weight, BMI, and Body Composition in a Population-Based Intervention Versus Genetic-Based Intervention: The NOW Trial. Obesity (Silver Spring). 2020 Aug;28(8):1419-1427. doi: 10.1002/oby.22880. PMID: 32935529.
Rosenfalck AM, Almdal T, Hilsted J, Madsbad S. Body composition in adults with Type 1 diabetes at onset and during the first year of insulin therapy. Diabet Med. 2002 May;19(5):417-23. doi: 10.1046/j.1464-5491.2002.00702.x. PMID: 12027931.
Aleksandra A, Bandurska-Stankiewicz E, Borys S, Budzyński A, Cyganek K, Cypryk K, Czech A, Czupryniak L, Drzewoski J, Dzida G, Dziedzic T, Franek E, Gajewska D, Gawrecki A, Górska M, Grzeszczak W, Gumprecht J, Idzior-Waluś B, Jarosz-Chobot P, Kalarus Z, Karczewska-Kupczewska M, Klupa T, Koblik T, Kokoszka A, Korzon-Burakowska A, Kowalska I, Krętowski A, Majkowska L, Małecki M, Mamcarz A, Mirkiewicz-Sieradzka B, Młynarski W, Moczulski D, Myśliwiec M, Narkiewicz K, Noczyńska A, Rymaszewska J, Sieradzki J, Skupień J, Solnica B, Strączkowski M, Strojek K, Szadkowska A, Szelachowska M, Szypowska A, Uruska A, Wender-Ożegowska E, Wierusz-Wysocka B, Witek P, Wolnik B, Wyleżoł M, Wylęgała E, Zozulińska-Ziółkiewicz D. 2021 Guidelines on the management of patients with diabetes. A position of Diabetes Poland. Clin Diabetol 2021 Feb;10 (1), s. 1–113. doi: 10.5603/DK.2021.0001.
The Diabetes Control And Complications Trial Research Group. Influence of intensive diabetes treatment on body weight and composition of adults with type 1 diabetes in the Diabetes Control and Complications Trial. Diabetes Care. 2001 Oct;24(10):1711-21. doi: 10.2337/diacare.24.10.1711. PMID: 11574431; PMCID: PMC2663516.
Ferriss JB, Webb D, Chaturvedi N, Fuller JH, Idzior-Walus B; EURODIAB Prospective Complications Group. Weight gain is associated with improved glycaemic control but with adverse changes in plasma lipids and blood pressure isn Type 1 diabetes. Diabet Med. 2006 May;23(5):557-64. doi: 10.1111/j.1464-5491.2006.01847.x. PMID: 16681565.
Carlson MG, Campbell PJ. Intensive insulin therapy and weight gain in IDDM. Diabetes. 1993 Dec;42(12):1700-7. doi: 10.2337/diab.42.12.1700. PMID: 8243815.
Duren DL, Sherwood RJ, Czerwinski SA, Lee M, Choh AC, Siervogel RM, Cameron Chumlea W. Body composition methods: comparisons and interpretation. J Diabetes Sci Technol. 2008 Nov;2(6):1139-46. doi: 10.1177/193229680800200623. PMID: 19885303; PMCID: PMC2769821.
Schauer IE, Snell-Bergeon JK, Bergman BC, Maahs DM, Kretowski A, Eckel RH, Rewers M. Insulin resistance, defective insulin-mediated fatty acid suppression, and coronary artery calcification in subjects with and without type 1 diabetes: The CACTI study. Diabetes. 2011 Jan;60(1):306-14. doi: 10.2337/db10-0328. Epub 2010 Oct 26. PMID: 20978091; PMCID: PMC3012187.
Kilpatrick ES, Rigby AS, Atkin SL. Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: "double diabetes" in the Diabetes Control and Complications Trial. Diabetes Care. 2007 Mar;30(3):707-12. doi: 10.2337/dc06-1982. PMID: 17327345.
Kim MK, Han K, Koh ES, Kim ES, Lee MK, Nam GE, Kwon HS. Weight change and mortality and cardiovascular outcomes in patients with new-onset diabetes mellitus: a nationwide cohort study. Cardiovasc Diabetol. 2019 Mar 19;18(1):36. doi: 10.1186/s12933-019-0838-9. PMID: 30890169; PMCID: PMC6423842.
Yamada E, Okada S, Nakajima Y, Bastie C, Tagaya Y, Osaki A, Shimoda Y, Shibusawa R, Saito T, Ozawa A, Yamada M. Assessment of factors determining an HbA1c concentration ≤7.5% in patients with type 1 diabetes. J Diabetes. 2018 Feb;10(2):140-147. doi: 10.1111/1753-0407.12572. Epub 2017 Jun 28. PMID: 28544548.
Alvim RO, Cheuhen MR, Machado SR, Sousa AG, Santos PC. General aspects of muscle glucose uptake. An Acad Bras Cienc. 2015 Mar;87(1):351-68. doi: 10.1590/0001-3765201520140225. Epub 2015 Mar 6. PMID: 25761221.
Corbin KD, Driscoll KA, Pratley RE, Smith SR, Maahs DM, Mayer-Davis EJ; Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON). Obesity in Type 1 Diabetes: Pathophysiology, Clinical Impact, and Mechanisms. Endocr Rev. 2018 Oct 1;39(5):629-663. doi: 10.1210/er.2017-00191. PMID: 30060120.
Rawshani A, Rawshani A, Franzén S, Eliasson B, Svensson AM, Miftaraj M, McGuire DK, Sattar N, Rosengren A, Gudbjörnsdottir S. Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes. N Engl J Med. 2017 Apr 13;376(15):1407-1418. doi: 10.1056/NEJMoa1608664. PMID: 28402770.
How to Cite
Copyright (c) 2021 The copyright to the submitted manuscript is held by the Author, who grants the Journal of Medical Science (JMS) a nonexclusive licence to use, reproduce, and distribute the work, including for commercial purposes.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.