Department of Paediatrics, Endocrinology, and Diabetology with Cardiology Division, Medical University of Bialystok, Białystok, Poland.
Front Endocrinol (Lausanne). 2022 Jun 16;13:890833. doi: 10.3389/fendo.2022.890833. eCollection 2022.
The prevalence of overweight and obesity among youth patients with diabetes type 1 is increasing. It is estimated, that even up to 35% of young patients with this type of diabetes, considered so far to be characteristic for slim figure, are overweight or even obese. General increase of obesity in children's population complicates differential diagnosis of the type of diabetes in youths. Coexistence of obesity has clinical implications for all stages of diabetes course. It is confirmed that obesity is the risk factor for autoimmune diabetes, and is connected with the earlier onset of diabetes in predisposed patients. Many diabetic patients with obesity present additional risk factors for macroangiopathy, and are recognised to present metabolic syndrome, insulin resistance, and typical for diabetes type 2 - polycystic ovary syndrome, or non-alcoholic fatty liver disease. The prevalence of obesity rises dramatically in adolescence of diabetic child, more often in girls. It has negative impact on metabolic control, glycaemic variability and insulin demand. The risk for microangiopathic complications increases as well. The treatment is difficult and includes not only insulinotherapy and non-pharmacological trials. Recently treatment of insulin resistance with biguanids, and treatment with typical for type 2 new diabetes drugs like GLP-1 analogues, SGLT-2 receptor inhibitors, or even cases of bariatric surgery also has been reported.
超重和肥胖在青少年 1 型糖尿病患者中的发病率正在上升。据估计，即使在迄今为止被认为体型偏瘦的年轻 1 型糖尿病患者中，也有高达 35%的患者超重甚至肥胖。儿童肥胖人数的普遍增加使得青少年糖尿病的类型鉴别变得复杂。肥胖的共存对糖尿病病程的所有阶段都有临床意义。已经证实肥胖是自身免疫性糖尿病的危险因素，并且与易感患者的糖尿病更早发病有关。许多肥胖的糖尿病患者存在大血管病变的其他危险因素，并且被认为存在代谢综合征、胰岛素抵抗以及 2 型糖尿病特有的多囊卵巢综合征或非酒精性脂肪肝疾病。肥胖在糖尿病儿童的青春期急剧上升，在女孩中更为常见。它对代谢控制、血糖变异性和胰岛素需求产生负面影响。微血管并发症的风险也会增加。治疗很困难，不仅包括胰岛素治疗和非药物试验。最近，二甲双胍治疗胰岛素抵抗，以及用 GLP-1 类似物、SGLT-2 受体抑制剂等新型 2 型糖尿病药物治疗，甚至报告了减肥手术的案例。
