Introduction: Comorbid obesity and type 1 diabetes (T1D) were previously rare, but the prevalence of overweight/obesity among youth with T1D now exceeds that of youth in the general population, significantly increasing cardiovascular risk. While the ADA recommends lifestyle modifications for youth with T1D and elevated cardiovascular risk, uptake is limited. The study purpose was to identify barriers to healthy lifestyle behavior engagement and T1D management concurrently.

Methods: Adolescents with comorbid T1D and BMI≥85th percentile (n=12; M(SD) age=15(1.2) years, 58% female) and their caregivers (n=12; 67% female) participated in individual interviews concerning adolescents’ engagement in healthy lifestyle behaviors and T1D management. Caregivers completed a demographics questionnaire, and adolescents completed the Barriers to Diabetes Adherence (BDA) measure. Interviews were transcribed verbatim, and two coders independently analyzed the data using thematic analysis. Coders came to 100% agreement on all codes.

Results: During interviews, 83% of adolescents reported wanting to change their weight/body shape. Three themes emerged from the interviews: (1) Discomfort with aspects of T1D management that draw attention to themselves and their illness; (2) Barriers to setting up environments that encourage healthy behaviors; and (3) Physiological dysregulation (i.e., aspects of T1D management that disrupt internal signals like hunger and sleep). Adolescents rated time (25%) and social support (16.7%) as the primary barriers to T1D adherence on the BDA.

Conclusions: Adolescents with T1D and overweight/obesity experience common barriers to healthy living that are exacerbated by environmental challenges and T1D management requirements. Specific recommendations on how to manage healthy living, weight/shape, and T1D concurrently are needed. Results will inform the design of a healthy lifestyles program specific to adolescents with T1D.


J.Warnick: None. K.Darling: None. L.Swartz topor: None. E.Jelalian: None.


National Institutes of Health (T32HL076134)

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