Weight Management in Patients With Type 2 Diabetes Mellitus
Weight Management in Patients With Type 2 Diabetes Mellitus
Obesity is recognised as an important risk factor for type 2 diabetes, inducing insulin resistance and pancreatic beta-cell dysfunction. These obesity-related defects tend to progress following weight gain and can eventually lead to worsening hyperglycaemia over time. Thus, effective weight management is crucial for glycaemic control in overweight and obese patients with type 2 diabetes. Current standard strategies for weight management in these patients include lifestyle interventions and pharmacotherapy. Bariatric surgery has become a promising new option for the treatment of obese patients with type 2 diabetes and in recent years incretin-based therapies have become available, which exhibit favourable effects on body weight. Herein, the efficacy of available weight loss interventions is assessed and the role of newer antidiabetic agents examined, focusing on incretin-based therapies.
The prevalence of type 2 diabetes has risen dramatically over the past few decades, following the continually increasing obesity epidemic. Recent estimates suggest that around 80–90% of patients with type 2 diabetes are overweight or obese. Evidence from large-scale population studies strongly supports this close association, identifying obesity as one of themost important risk factors for type 2 diabetes. Furthermore, accumulation of abdominal fat is also directly associated with an increased risk of obesity-related cardiometabolic complications, and waist circumference has been recognised as an independent risk factor for type 2 diabetes.
Obesity is the cornerstone of type 2 diabetes pathophysiology, inducing both insulin resistance and pancreatic beta-cell dysfunction. These underlying disease mechanisms usually progress for several years before the clinical onset of type 2 diabetes, and if the excess fat mass is maintained or increases over time, hyperglycaemia is likely to become progressively worse. Thus, weight loss is crucial in preventing the progression of pre-diabetes to frank type 2 diabetes. Furthermore, in patients who have already been diagnosed with type 2 diabetes, weight loss may help slow the natural history of the disease and delay the need for intensification of therapy to insulin. However, weight reduction in overweight and obese patients with type 2 diabetes can prove challenging. Typically these patients lose less weight and at slower rates than non-diabetic individuals, due to metabolic dysregulation, potential comorbidities that restrict physical activity and a lack of dietary adherence. This problem is further complicated by weight gain associated with many antidiabetic therapies, including some oral glucose-lowering agents (i.e. sulphonylureas, glinides and TZDs), insulin, and also, several medications prescribed for common diabetes comorbidities(certain beta-blockers, antidepressants, antipsychotics and neurological agents).
Importantly, it has been shown that in patients with type 2 diabetes even a modest sustained reduction of the initial body weight (5–10%) can significantly mitigate diabetes-related complications by improving glycaemic control, lipid profiles and blood pressure.
This review aims to provide a concise overview of the available weight management options for overweight and obese patients with type 2 diabetes, focusing on the efficacy of lifestyle interventions, pharmacotherapy and bariatric surgery, as well as the effect of incretin-based therapies on body weight. Several weight management options have been shown to prevent the onset of type 2 diabetes in overweight individuals; however, diabetes prevention is beyond the scope of this review and will not be covered here.
Abstract and Introduction
Abstract
Obesity is recognised as an important risk factor for type 2 diabetes, inducing insulin resistance and pancreatic beta-cell dysfunction. These obesity-related defects tend to progress following weight gain and can eventually lead to worsening hyperglycaemia over time. Thus, effective weight management is crucial for glycaemic control in overweight and obese patients with type 2 diabetes. Current standard strategies for weight management in these patients include lifestyle interventions and pharmacotherapy. Bariatric surgery has become a promising new option for the treatment of obese patients with type 2 diabetes and in recent years incretin-based therapies have become available, which exhibit favourable effects on body weight. Herein, the efficacy of available weight loss interventions is assessed and the role of newer antidiabetic agents examined, focusing on incretin-based therapies.
Introduction
The prevalence of type 2 diabetes has risen dramatically over the past few decades, following the continually increasing obesity epidemic. Recent estimates suggest that around 80–90% of patients with type 2 diabetes are overweight or obese. Evidence from large-scale population studies strongly supports this close association, identifying obesity as one of themost important risk factors for type 2 diabetes. Furthermore, accumulation of abdominal fat is also directly associated with an increased risk of obesity-related cardiometabolic complications, and waist circumference has been recognised as an independent risk factor for type 2 diabetes.
Obesity is the cornerstone of type 2 diabetes pathophysiology, inducing both insulin resistance and pancreatic beta-cell dysfunction. These underlying disease mechanisms usually progress for several years before the clinical onset of type 2 diabetes, and if the excess fat mass is maintained or increases over time, hyperglycaemia is likely to become progressively worse. Thus, weight loss is crucial in preventing the progression of pre-diabetes to frank type 2 diabetes. Furthermore, in patients who have already been diagnosed with type 2 diabetes, weight loss may help slow the natural history of the disease and delay the need for intensification of therapy to insulin. However, weight reduction in overweight and obese patients with type 2 diabetes can prove challenging. Typically these patients lose less weight and at slower rates than non-diabetic individuals, due to metabolic dysregulation, potential comorbidities that restrict physical activity and a lack of dietary adherence. This problem is further complicated by weight gain associated with many antidiabetic therapies, including some oral glucose-lowering agents (i.e. sulphonylureas, glinides and TZDs), insulin, and also, several medications prescribed for common diabetes comorbidities(certain beta-blockers, antidepressants, antipsychotics and neurological agents).
Importantly, it has been shown that in patients with type 2 diabetes even a modest sustained reduction of the initial body weight (5–10%) can significantly mitigate diabetes-related complications by improving glycaemic control, lipid profiles and blood pressure.
This review aims to provide a concise overview of the available weight management options for overweight and obese patients with type 2 diabetes, focusing on the efficacy of lifestyle interventions, pharmacotherapy and bariatric surgery, as well as the effect of incretin-based therapies on body weight. Several weight management options have been shown to prevent the onset of type 2 diabetes in overweight individuals; however, diabetes prevention is beyond the scope of this review and will not be covered here.
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