Obesity And Glycemic Control

It is noteworthy that BMI is the most important predictor of deterioration in glycemic control, regardless of the treatment regimen, according to a study from Finland (25). Moreover, in this study, there was significantly greater decrease in HbA1c levels in patients whose baseline weight was below the mean in those whose weight was above this cutoff value (1.7 vs. 0.5 %, p< 0.01). For this reason, there is now agreement that prevention of weight gain is an important target when drug treatment is initiated in obese subjects with type 2 diabetes (29). This aspect is particularly significant in insulin-treated patients independent of the type of diabetes.

Management of Obesity in Subjects with Type 2 Diabetes

The management of obesity represents a central component in the treatment strategy for type 2 diabetes, as obesity is not only a major predisposing factor of the disease and its accompanying disorders, but also aggravates the achievement of a good metabolic control. Moreover, it was repeatedly shown that reducing excessive body weight in individuals with type 2 diabetes improves metabolic control and prolongs life (30-33). However, currently available weight reduction programs for patients suffering from diabetes turned out to have only limited success, particularly in the long run. An essential prerequisite for successful treatment are realistic goals. This is particularly important for this group as treatment of obese subjects with type 2 diabetes is usually more difficult than treating obese subjects without diabetes for several reasons. Type 2 diabetic subjects are usually older than nondiabetic obese subjects, which means a smaller weight loss as energy expenditure is decreasing with age. Another reason is that subjects with diabetes are focusing more on blood glucose control, which could result in the neglect of other health problems. Finally, the weight increasing and weight loss preventing potential of antidiabetic agents has to be considered. Irrespective of these specific considerations, the indications, goals and principles of treatment are the same in obese subjects with and without type 2 diabetes (Tabels 3 and 4). Table 5 summarizes in a flowchart current evidence-based therapeutic approaches for the prevention and treatment of obesity depending on the degree of overweight and the presence of comorbidities, which are also valid for overweight/obese subjects with type 2 diabetes.

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