The landscape of type 1 diabetes (T1D) management is undergoing a significant transformation as healthcare providers grapple with an increasing prevalence of obesity among patients, according to Matthew Budoff, MD, professor of medicine at the David Geffen School of Medicine at UCLA and investigator at The Lundquist Institute.
Speaking at the 22nd Annual World Congress Insulin Resistance Diabetes & Cardiovascular Disease (WCIRDC), Budoff highlighted how T1D, historically considered a condition affecting primarily lean individuals, now frequently presents alongside obesity and its associated cardiometabolic complications.
Evolving Disease Profile and Cardiovascular Risks
The convergence of T1D and obesity brings additional health challenges, including hypertension, dyslipidemia, and elevated risks of myocardial infarction and stroke. This trend mirrors the broader obesity epidemic, with forecasts suggesting that half of all U.S. adults will be classified as obese by 2030.
The traditional insulin-centric approach to T1D management may actually compound cardiovascular risks by potentially exacerbating atherosclerosis, necessitating a fundamental shift in treatment strategies.
Emerging Therapeutic Approaches
Novel therapeutic options are showing promise in addressing both weight management and cardiovascular protection. Sodium-glucose co-transporter (SGLT) 1/2 inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists represent particularly promising avenues for treatment.
While GLP-1 receptor agonists have not yet received approval for glucose control in T1D, their demonstrated benefits in weight reduction and cardiovascular risk mitigation could revolutionize patient care. Budoff characterized the "obesity revolution" as this year's most significant advancement in cardiology, citing the expanding evidence base for GLP-1 receptor agonists across multiple indications.
Preventive Strategies and Screening Recommendations
To address the growing cardiovascular risks in T1D patients, Budoff advocates for early intervention through calcium scoring or CT angiography. These diagnostic tools can identify subclinical atherosclerosis, enabling healthcare providers to implement aggressive preventive measures before complications arise.
The versatility of newer therapeutic options, particularly GLP-1 receptor agonists, positions them as potentially transformative treatments capable of addressing the complex relationship between obesity, diabetes, and cardiovascular health. Their demonstrated efficacy across weight loss, cardiovascular risk reduction, and heart failure with preserved ejection fraction (HFpEF) underscores their potential impact on patient care.
