Abstract
Adipose tissue, once regarded merely as an energy reservoir, has emerged as a critical regulator of both metabolic and immune processes. This paradigm shift has profound implications for understanding and managing type 1 diabetes, a condition typically associated with lean individuals. The growing global prevalence of obesity has introduced an underexplored dimension to type 1 diabetes pathophysiology, a phenomenon that has significant consequences for disease development, progression and management. The coexistence of obesity and type 1 diabetes presents unique challenges, including exacerbation of insulin resistance and an elevated risk of complications such as CVD. Obesity-induced chronic low-grade inflammation, or 'meta-inflammation', creates a proinflammatory environment within adipose tissue. This disrupts systemic immune regulation, promotes insulin resistance and may even potentiate autoimmunity directed to pancreatic beta cells. Addressing these interactions will allow us to reframe research priorities and the management of type 1 diabetes in individuals who also live with obesity. In this review, we explore how adipose tissue maladaptation in obesity influences the pathophysiology of type 1 diabetes. We discuss existing literature and gaps in knowledge, and emphasise the importance of addressing these gaps. We also highlight the potential of emerging technologies and precision medicine to tackle the dual challenge of obesity and type 1 diabetes. Advances such as continuous glucose monitoring and automated insulin delivery systems and insights from genomics and metabolomics are revolutionising diabetes care. These tools can enhance glucose management and provide opportunities to mitigate weight-related complications and personalise treatment strategies.