Division of Pediatric Endocrinology and Diabetes, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States.
Front Endocrinol (Lausanne). 2021 Mar 22;12:622901. doi: 10.3389/fendo.2021.622901. eCollection 2021.
Since the 1980s, there has been a dramatic rise in the prevalence of overweight and obesity in pediatric populations, in large part driven by sedentary lifestyles and changing dietary patterns with more processed foods. In parallel with the rise in pediatric obesity in the general population, the prevalence of overweight and obesity has increased among children and adolescents with type 1 diabetes. Adiposity has been implicated in a variety of mechanisms both potentiating the risk for type 1 diabetes as well as exacerbating long-term complications, particularly cardiovascular disease. Treatment options targeting the unique needs of obese pediatric patients, both before and after diagnosis of type 1 diabetes, are limited. In this review, we discuss the history of the epidemiology of the obesity epidemic in the context of pediatric type 1 diabetes, highlight the possible role of obesity in type 1 diabetes pathogenesis and review the concept of "double diabetes". The impact of obesity at and after diagnosis will be discussed, including noted differences in clinical and biochemical markers, lipid abnormalities, and long-term cardiovascular complications. Finally, we will review the existing literature on pharmacologic and nutritional interventions as potential treatment strategies for youth with coexisting type 1 diabetes and obesity.
自 20 世纪 80 年代以来，儿童人群中超重和肥胖的患病率显著上升，这在很大程度上是由 sedentary lifestyles 和饮食习惯的改变导致的，人们摄入了更多的加工食品。与普通人群中儿童肥胖率的上升并行的是，1 型糖尿病儿童和青少年的超重和肥胖患病率也有所增加。肥胖与多种机制有关，既增加了 1 型糖尿病的发病风险，又加重了长期并发症，特别是心血管疾病。针对肥胖儿科患者的独特需求的治疗选择，无论是在 1 型糖尿病诊断之前还是之后，都很有限。在这篇综述中，我们讨论了肥胖症在儿科 1 型糖尿病中的流行病学历史，强调了肥胖在 1 型糖尿病发病机制中的可能作用，并回顾了“双重糖尿病”的概念。我们将讨论肥胖在诊断时和诊断后的影响，包括临床和生化标志物、脂质异常和长期心血管并发症方面的显著差异。最后，我们将回顾现有的关于肥胖的药理学和营养干预的文献，作为同时患有 1 型糖尿病和肥胖的青少年的潜在治疗策略。
