Many people are aware that children and teens who are overweight or obese are at risk for type 2 diabetes, but the obesity epidemic also affects those with type 1 diabetes.
Nearly 40 percent of children or teens with Type 1 diabetes were obese or overweight in a recent study by the T1D Exchange, a network of over 70 clinics – including the Yale Pediatric Diabetes Program - working together to advance type 1 diabetes treatment and research. Children and teens with diabetes already have a higher risk of developing cardiovascular disease as a long term complication of diabetes. “If you’re overweight or obese on top of that you’re increasing your risk for early cardiovascular disease and other complications,” said pediatric endocrinologist Eda Cengiz, MD, MHS.
Type 1 diabetes traditionally treated solely with insulin, can be challenging to control. The A1C test measures blood sugar control over a two to three month period. The average A1C in the U.S. for pediatric patients is 9 percent, but Dr. Cengiz said the goal is less than 7.5%. Controlling blood sugar levels is even more challenging for kids and adolescents who are overweight or obese, because they are more prone to insulin resistance, which is typically associated with type 2 diabetes.
Dr. Cengiz, along with doctors at five other sites, is conducting a study to find out if metformin, a medication normally used to reduce insulin resistance in type 2 diabetes, can improve insulin sensitivity and blood sugar control in adolescents with type 1 diabetes.Dr. Cengiz, along with doctors at five other sites, is conducting a study to find out if metformin, a medication normally used to reduce insulin resistance in type 2 diabetes, can improve insulin sensitivity and blood sugar control in adolescents with type 1 diabetes. “The idea is to add medication not used routinely with type 1 diabetes to see if we can improve overall blood sugar control and reduce the risk for cardiovascular disease and increase insulin sensitivity,” she said.
If you’re overweight or obese on top of that you’re increasing your risk for early cardiovascular disease and other complications.
Eda Cengiz, MD, MHS
The idea of adding a second medication to treat type 1 diabetes is relatively new. Studies like the one conducted by the T1D Exchange that collect and analyze information from many thousands of patients are helping doctors better understand diabetes. This research highlighted how poorly controlled type 1 diabetes is in children and is giving momentum to trying to improve treatment, with an ultimate goal of reducing complications of diabetes. Dr. Cengiz said this is paving the way for testing other medications to better control blood sugar in children with type 1 diabetes.
“We need to conduct research studies to advance the field,” she said, adding that this involves team work from doctors, researchers and patients. “We need to start answering these questions today for a better future tomorrow.”
Adolescents ages 12 through 20 who have had type 1 diabetes for at least one year may be eligible for the metformin study. For more information, contact Amy Steffen, RN, at amy.steffen@yale.edu or 203-737-8852.