Is there a link between weight and type 1 diabetes management?

In recent years, more attention has been given to the growing presence of overweight and obesity among people living with type 1 diabetes (T1D). Our recent study, based on data from the BETTER registry, the first registry of people living with T1D in Canada, sheds light on this matter and explores the connections between body weight and T1D management.

We looked at self-reported data of 1091 adults from the registry. We found that overweight or obesity can add unique challenges to life with T1D. Excess weight can lead to insulin resistance, making blood sugar management even more difficult and increasing the risk of some T1D-related complications (e.g. heart disease). But, our study also highlights an important point: understanding these challenges can empower people with T1D to make informed decisions about their health.

Excess weight is frequent and associated with higher HbA1c

Based on the participants’ reported weight and height, we found that 1 in 3 live with overweight, defined as a BMI over 25 (weight in kg/height in m2), while 1 in 5 live with obesity, defined as a BMI over 30. One of the significant findings from our study is that overweight and obesity are linked to higher HbA1c levels (or glycated hemoglobin, i.e. the average blood sugar level over 3 months). This means that excess body weight could make it harder to keep blood sugar levels within the target range (between 4.0 and 10,0 mmol/L), and can be associated with a higher risk of T1D-related complications.

Practical steps for managing weight and diabetes

Research shows good evidence about how we can manage weight while living with T1D. Here are some lifestyle behaviors that are beneficial to T1D, health in general, and weight management:

1. Move as much as you can: Many studies support the idea that regular activity can reduce the risk of health complications and improve physical and mental health. It also improves insulin sensitivity and usually makes it easier to manage blood sugar levels. Try to get at least 30 minutes of moderate activity most days of the week, for a total of about 150 minutes per week. This could be anything from walking to dancing, taking the stairs instead of elevators, or playing with your kids – the key is to find something you love! Even short periods of walking (e.g. 3 minutes every 20 to 30 minutes) have a very significant effect on glucose spikes after meals. The health profile of physically active individuals living with overweight or obesity is very often better than that of lower weight but sedentary individuals.
2. Enjoy a balanced diet: Add more whole foods like fruits, vegetables, lean proteins, and whole grains to your plate. Bonus points: once you find whole foods that you like, use them to replace less nutritional foods. For instance, swap candy with some berries. 
3. Monitor your blood sugar: Keeping a close eye on your blood sugar levels can help you understand how your body responds to different foods and activities. This can give you valuable insights into what works best for you and where you might need to make adjustments.
4. Set bite-sized goals: If you want to lose weight, setting achievable goals is important. Whether it’s losing a few pounds and/or improving food quality and/or increasing your physical activity, start with small, manageable steps. Over time, these small changes can add up to big improvements in your health. Even if you are not losing weight on the scale, losing waist circumference is a very good indication of an improved health profile. 
5. Reassess your list of medications with your healthcare team: outside of T1D management, some medications (e.g. for mental health) can increase the risk of weight gain. Ask your doctor about alternatives that bring the same benefits with less risk of putting on weight.
6. Monitor your insulin needs: if you do lose weight, you might need less insulin. Monitor your blood sugar levels closely to adjust your insulin doses and minimize hypoglycemic episodes.
7. Stay positive: It’s easy to feel discouraged if you’re not seeing immediate results, but remember that progress takes time. Celebrate your successes, no matter how small, and stay focused on your long-term goals.

Take charge of your health

The findings from our study underline the fact that a large fraction of people living with T1D can face excess weight, which could expose them to a higher risk for some complications. If weight management is important for you or your health, making small, sustainable changes can improve your health, boost your energy, and reduce your risk of complications.

Remember, you’re not alone in this journey. Whether it’s through support from healthcare providers, friends, or family, having a strong support system can make all the difference. Don’t be afraid to reach out for help if you need it. 

Let’s take charge of our health – one step at a time!

Useful resource:

• BETTER webinar – Weight loss and type 1 diabetes

References :

• Lalanne-Mistrih, L., et al.(2024). Overweight and Obesity in People Living With Type 1 Diabetes: A Cross-Sectional Analysis of the BETTER Registry. Diabetes/Metabolism Research and Reviews, 40(6), e3837.
• Donga, E., Dekkers, O.M., Corssmit, E.P., Romijn, J.A. (2015). Insulin resistance in patients with type 1 diabetes assessed by glucose clamp studies: systematic review and meta-analysis. European journal of endocrinology / European Federation of Endocrine Societies, 173(1):101-9.
• Sigal, R.J., et al. (2018). Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Physical Activity and Diabetes. Can J Diabetes,42(Suppl 1):S54-S63.
• Sievenpiper, J.L., Chan, C.B., Dworatzek, P.D., Freeze, C., Williams, S.L. (2018). Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Nutrition Therapy. Can J Diabetes, 42(Suppl 1):S64-S79.