Weight Management in Youth with Type 1 Diabetes and Obesity: Challenges and Possible Solutions
Open accessAbstract
Purpose of review This review highlights challenges associated with weight management in children and adolescents with type 1 diabetes (T1D). Our purpose is to propose potential solutions to improve weight outcomes in youth with T1D. Recent findings A common barrier to weight management in T1D is reluctance to engage in exercise for fear of hypoglycemia. Healthcare practitioners generally provide limited guidance for insulin dosing and carbohydrate modifications to maintain stable glycemia during exercise. Adherence to dietary guidelines is associated with improved glycemia; however, youth struggle to meet recommendations. When psychosocial factors are addressed in combination with glucose trends, this often leads to successful T1D management. Newer medications also hold promise to potentially aid in glycemia and weight management, but further research is necessary. Properly addressing physical activity, nutrition, pharmacotherapy, and psychosocial factors while emphasizing weight management may reduce the likelihood of obesity development and its perpetuation in this population.
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The findings support the idea that adolescents with Type 1 diabetes and/or their parents experience increased stress due to the potential of hypoglycemia during sports and other physical activities.
“Our findings support the idea that adolescents with and/or parents of adolescents withT1D experience an increased level of stress due to the potential of hypoglycemia during sports and other physical activities (Roberts et al., 2020; Zaharieva et al., 2020).”
From “Diabetes is really simple on paper, but really complicated when you actually have it”: Understanding the daily stressors of adolescents living with Type 1 diabetes (2024) · cites this paper as Zaharieva et al., 2020
The Exercise and Physical Activity section (page unavailable) identifies fear of hypoglycemia as a primary barrier to physical activity for youth with type 1 diabetes, supporting the concern attributed to adolescents. It does not establish increased stress levels or say that parents experience stress specifically because of hypoglycemia risk during activity. (LLM, conf=0.84)
Experimental — accuracy not yet measuredAdolescents with Type 1 diabetes struggle with glycemic excursions that occur as a result of physical activity.
“adolescents with T1D struggle with glycemic excursions that occur as a result of physical activity (Chetty et al., 2019; Logan et al., 2019; Zaharieva et al., 2020).”
From “Diabetes is really simple on paper, but really complicated when you actually have it”: Understanding the daily stressors of adolescents living with Type 1 diabetes (2024) · cites this paper as Zaharieva et al., 2020
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Exercise and bone mineral accrual in children and adolescents.
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CGM Initiation Soon After Type 1 Diabetes Diagnosis Results in Sustained CGM Use and Wear Time
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Çocuklarda Obezite Tedavisinde Egzersiz
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The Influence of Physical Activity on Cigarette Smoking Among Adolescents: Evidence From Add Health
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Incretin-based therapies for patients with type 1 diabetes: a meta-analysis
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Cardiovascular risk factors in children with type 1 diabetes mellitus
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Impaired Energy Expenditure Despite Normal Cardiovascular Capacity in Children with Type 1 Diabetes
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Low carbohydrate diet and improved glycaemic control in a patient with type one diabetes
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The influence of food order on postprandial glucose levels in children with type 1 diabetes
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Children's Physical Activity and Sedentary Time and Cardiometabolic Risk Factors
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A 5-year exercise program in children improves muscle strength without affecting fracture risk
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Physical activity and academic achievements
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Strategies That Adolescents With Type 1 Diabetes Use in Relation to Exercise
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Annan, S. F., Higgins, L. A., Jelleryd, E., Hannon, T., Rose, S., Salis, S., Baptista, J., Chinchilla, P., & Marcovecchio, M. L. (2022) · Pediatric Diabetes · doi:10.1111/pedi.13429 · Cited by 143 · see citing works
Obesity in Patients with Type 1 Diabetes: Links, Risks and Management Challenges
Vilarrasa, N., José, P. S., Rubio, M. Á., & Lecube, A. (2021) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s223618 · Cited by 91 · see citing works
Ciężki, S., Kurpiewska, E., Bossowski, A. T., & Głowińska‐Olszewska, B. (2022) · Frontiers in Endocrinology · doi:10.3389/fendo.2022.890833 · Cited by 44 · see citing works
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Preventing Cardiovascular Complications in Type 1 Diabetes: The Need for a Lifetime Approach
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Self-citationChange in Body Mass Index in Youth in the First 5 Years After Type 1 Diabetes Mellitus Diagnosis
Ganta, A., Warnick, J. L., Has, P., Gonzalez, M. S., Fredette, M. E., & Topor, L. S. (2024) · Endocrine Practice · doi:10.1016/j.eprac.2024.05.003 · Cited by 5 · see citing works
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Dietary Factors Associated with Glycemic Control in Children and Adolescents with Type 1 Diabetes
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Weight stigma in pediatric type 1 diabetes: An associated risk for disordered eating?
Trojanowski, P. J., Warnick, J. L., Darling, K. E., Tanner, B., Shomaker, L. B., & O’Donnell, H. K. (2025) · Journal of Health Psychology · doi:10.1177/13591053241311755 · Cited by 1 · see citing works
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Beyond Two Cultures: Cultural Infrastructure for Data-driven Decision Support
Freeman, N. L. B., Sperger, J., El-Zaatari, H., Kahkoska, A. R., Lu, M., Valancius, M., Virkud, A., Zikry, T. M., & Kosorok, M. R. (2021) · Observational Studies · doi:10.1353/obs.2021.0024 · Cited by 1 · see citing works
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Self-citationObesity in Patients with Type 1 Diabetes: Causes and Consequences
Klimontov, V. V., & Yushin, A. Y. (2025) · Diabetes Mellitus · doi:10.14341/dm13237
- Authors
- Zaharieva, D. P., Addala, A., Simmons, K. M., & Maahs, D. M.
- Affiliations
- Stanford Medicine (US)
- University of Colorado Anschutz (US)
- Corresponding author
- Zaharieva, Dessi P.
- Venue
- Current Obesity Reports
- Published
- 2020-10-27
- Volume
- 9
- Issue
- 4
- Pages
- 412-423
- ISSN
- 2162-4968 (ISSN-L)
- PMC
- PMC8087153
- OpenAlex
- W3097100621
- Cited by
- 21
- References
- 122
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 6 · 2021: 3
- FWCI
- 0.50
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Current Obesity Reports (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (R18DK122422, K12DK122550, P30DK056350)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 1 diabetes, childhood obesity, weight management, adolescents, physical activity, hypoglycemia, insulin dose, carbohydrate modification, glycemic control, dietary adherence, psychosocial factors, pharmacotherapy
- MeSH terms
- Obesity Management, Glycemic Control, Adolescent, Child, Diabetes Mellitus, Type 1, Female, Humans, Male, Pediatric Obesity
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