Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation

The Lancet ◽  
2021 ◽  
Author(s):  
Ildiko Lingvay ◽  
Priya Sumithran ◽  
Ricardo V Cohen ◽  
Carel W le Roux
Keyword(s):  
Type 2 Diabetes ◽  
Primary Treatment ◽  
Treatment Goal ◽  
Obesity Management

scholarly journals THE FAMILY DOCTOR’S ROLE IN ACHIEVING TARGET LEVELS OF TREATMENT IN PATIENTS WITH TYPE 2 DIABETES

2020 ◽  
Vol 72 (2) ◽  
pp. 51-58
Author(s):  
О. Korzh ◽  
A. Titkova ◽  
M. Kochuieva ◽  
Yu. Vinnyk ◽  
L. A. Ruban ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Microvascular Complications ◽  
Vascular Complications ◽  
Lifestyle Changes ◽  
Treatment Goal ◽  
Treatment Goals ◽  
Factors Associated ◽  
Triple Treatment

The aim of the study was to identify the proportion of patients with type 2 diabetes who were unable toachieve the triple treatment goal for concomitant control of blood glucose level, blood pressure, LDL and modifying factors associated with achieving triple therapy goals. The study included 675 patients with type 2 diabetes,dyslipidemia and hypertension. The analysis was performed using concurrent triple treatment goals with specific levels of HbA1c, LDL and blood pressure as the main result. The questionnaire for patients with dyslipidemiaincluded self-assessment of compliance with prescribed drugs and perceptions related to their understandingand attitude towards lifestyle changes and pharmacological treatment. The results of the analysis of the logistic regression of factors associated with the achievement of triple treatment goals showed that patients whoreceived moderate doses of statins with high intensity were less likely to achieve concurrent treatment of thegoal compared to low intensity. Younger patients were less likely to achieve the triple treatment goal than thoseover 60 years of age. Based on life expectancy, they will be more susceptible to vascular complications due to anearlier onset of the disease and a longer period of time during which these adverse events can develop. Fewerdrugs and a shorter duration of type 2 diabetes were significant factors in the triple control. It was proved thatsimultaneous control of glycemia, hypertension and lipids was achieved in 22.4% of patients, who were affectedby the intensity of statin treatment, the number of diabetic drugs and the presence of concomitant pathology.Thus, the simultaneous achievement of the triple goal is a more comprehensive mitigation measure to reduce therisk of both macro- and microvascular complications

Screening, Diagnosis, and Pharmacotherapy for Type 2 Diabetes Mellitus

2003 ◽  
Vol 16 (2) ◽  
pp. 127-137
Author(s):  
Steven B. Levy ◽  
Henry Cohen
Keyword(s):  
Type 2 Diabetes ◽  
Therapy Monitoring ◽  
Diagnostic Testing ◽  
The Elderly ◽  
Primary Treatment ◽  
Treatment Modalities ◽  
First Line ◽  
Glucosidase Inhibitors ◽  
Integral Role

Type 2 diabetes is increasing in prevalence. It is pragmatic to screen patients for diagnostic testing. Diet, exercise, and oral therapy remain the primary treatment modalities for type 2 diabetes. First generation sulfonylureas have fallen out of favor due to adverse effects. Second generation sulfonylureas, metformin, or their combinations are recommended first-line. Glipizide and glimepiride are preferred in elderly, hepatically, and renally impaired patients. Metformin is not recommended with chronic heart failure, renal insufficiency, and in the elderly due to lactic acidosis risks. Glitazones are for second-line therapy, should be used cautiously with cardiac insufficiencies, and require routine monitoring of liver enzymes. Meglitinides, not first-line, may offer an alternative to sulfonylureas. Alpha-glucosidase inhibitors, most effective with impaired glucose tolerance, may be combined with sulfonylureas or metformin. Pharmacists play an integral role in management and pharmacotherapy services in diabetes may be implemented in collaborative drug therapy monitoring for maximizing cost effectiveness.

scholarly journals Severe obesity in a specialist type 2 diabetes outpatient clinic: an Australian retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arunav Thakur ◽  
Dharmesh Sharma ◽  
Bhavya Gupta ◽  
Nikitha Kramadhari ◽  
Rohit Rajagopal ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Severe Obesity ◽  
Sglt2 Inhibitor ◽  
Outpatient Service ◽  
Obesity Management ◽  
Group 13 ◽  
Significant Difference ◽  
Service Referral

Abstract Background Obesity is a major risk factor for the development of type 2 diabetes (T2DM) and its complications. Significant weight loss has been shown to improve glycaemia in people with T2DM and obesity. National and international guidelines recommend considering bariatric surgery for body mass index (BMI) ≥ 35 kg/m2. We assessed the proportion of people with T2DM meeting criteria for surgery, how many had been offered a bariatric/obesity service referral, and compared the characteristics of people with BMI ≥ 35 kg/m2 and BMI < 35 kg/m2. Methods Retrospective data were collected for all people with T2DM aged ≥18 years, attending a hospital specialist diabetes outpatient service over three calendar years, 2017–2019. Results Of 700 people seen in the service, 291 (42%) had BMI ≥ 35 kg/m2 (the “BMI ≥ 35 group”) and met criteria for bariatric surgery, but only 54 (19%) of them were offered referral to an obesity service. The BMI ≥ 35 group was younger than those with a BMI < 35 kg/m2 (56.1 ± 14.8 vs 61.4 ± 14.6 years, p < 0.001) (mean ± SD), with similar diabetes duration (11.0 ± 9.0 vs 12.3 ± 8.9 years, p = 0.078), and there was no significant difference in initial HbA1c (75 ± 27 vs 72 ± 26 mmol/mol, p = 0.118) (9.0 ± 2.5 vs 8.7 ± 2.4%) or proportion treated with insulin (62% vs 58%). There was more GLP1 agonist use in the BMI ≥ 35 group (13% vs 7%, p = 0.003) but similar rates of SGLT2 inhibitor use (25% vs 21%, p = 0.202). The BMI ≥ 35 group received more new medication and/or dose adjustments (74% vs 66%, p = 0.016). Only 29% in the BMI ≥ 35 kg group achieved HbA1c < 53 mmol/mol (7.0%). Conclusions In spite of frequently meeting the criteria for bariatric surgery and not achieving glycaemic targets, people with T2DM in this specialist clinic received limited medical or surgical management of their obesity. This study suggests opportunities for improvement in care of people with T2DM at several levels including increased referrals from T2DM services to weight management/bariatric services, as well as an increased use of GLP1 agonists and SGLT2 inhibitors where appropriate. Our data support the need to prioritise obesity management in the treatment of type 2 diabetes.

scholarly journals Prevalence of Overweight and Obesity in Type 2 Diabetic Patients Visiting PHC in the Dubai Health Authority

2021 ◽  
pp. 1-5
Author(s):  
Noorah Bawady ◽  
Ola Aldafrawy ◽  
Elham Mohamed ElZobair ◽  
Wafaa Suliman ◽  
Amal Alzaabi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Primary Healthcare ◽  
Diabetic Patients ◽  
Obesity Management ◽  
Obesity And Overweight ◽  
Prevalence Of Obesity ◽  
Primary Healthcare Centers

<b><i>Background:</i></b> Diabetes is a highly prevalent global and local major health problem according to the International Diabetes Federation (IDF) and will double by 2045. A strong relationship between obesity and type 2 diabetes has been found. Both are leading causes of cardiovascular disease and death; thus, understanding the prevalence of obesity in type 2 diabetes is crucial for planning obesity management and preventing complications. <b><i>Objectives:</i></b> This study aimed to determine the prevalence of obesity and overweight among people with type 2 diabetes attending primary healthcare centers (PHC) in the Dubai Health Authority (DHA). <b><i>Methods:</i></b> The study sample consisted of type 2 diabetes mellitus patients who attended family medicine clinics in primary healthcare centers in DHA. All cases with type 2 diabetes attending family clinics for their periodic health checkup screening were included in the study. Patients &#x3c;18 years old, pregnant, and/or those with cancer and/or chronic kidney disease were excluded. <b><i>Results:</i></b> Our study sample had 9,198 type 2 diabetes mellitus cases with 51.6% males, 69.7% United Arab Emirates nationals, 7.9% who exercised regularly, and 1.8% who followed a healthy diet. Obesity and overweight cases were 49.5% and 35.5%, respectively. <b><i>Conclusion:</i></b> Without an aggressive obesity management approach, control of diabetes is difficult. The prevalence of obesity and overweight among people with type 2 diabetes is high. Obesity and overweight cases were 49.5% and 35.5%, respectively, among diabetic patients attending PHC. Over 50% (55%) of UAE nationals were obese, while 31.8% were overweight, suggesting that active interventions to control weight gain would be appropriate.

scholarly journals Severe Obesity in A Specialist Type 2 Diabetes Outpatient Clinic: An Australian Retrospective Cohort Study

2020 ◽  
Author(s):  
Arunav Thakur ◽  
Dharmesh Sharma ◽  
Bhavya Gupta ◽  
Nikitha Kramadhari ◽  
Rohit Rajagopal ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Bariatric Surgery ◽  
Severe Obesity ◽  
Sglt2 Inhibitor ◽  
Outpatient Service ◽  
Obesity Management ◽  
Group 13 ◽  
Significant Difference ◽  
Service Referral

Abstract Background Obesity is a major risk factor for the development of type 2 diabetes and its complications. Significant weight loss has been shown to improve glycaemia in people with type 2 diabetes (T2DM) and obesity. National and International guidelines recommend considering bariatric surgery for body mass index (BMI) ≥35 kg/m2. We assessed the proportion of people with T2DM meeting criteria for surgery, how many had been offered a bariatric/obesity service referral, and compared the characteristics of people with BMI≥35kg/m2 and BMI < 35 kg/m2.Methods Retrospective data were collected for all people with T2DM aged ≥18 years, attending a hospital specialist diabetes outpatient service over three calendar years, 2017–2019.Results Of 700 people seen in the service, 291 (42%) had BMI≥35kg/m2 (the “BMI≥35 group”) and met criteria for bariatric surgery, but only 54 (19%) of them were offered referral to an obesity service. The BMI≥35 group was younger than those with a BMI < 35 kg/m2 (56.1 ± 14.8 vs 61.4 ± 14.6 years, p < 0.001) (mean ± SD), with similar diabetes duration (11.0 ± 9.0 vs 12.3 ± 8.9 years, p = 0.078), and there was no significant difference in initial HbA1c (75 ± 27 vs 72 ± 26 mmol/mol, p = 0.118) (9.0 ± 2.5 vs 8.7 ± 2.4%) or proportion treated with insulin (62% vs 58%). There was more GLP1 agonist use in the BMI≥35 group (13% vs 7%, p = 0.003) but similar rates of SGLT2 inhibitor use (25% vs 21%, p = 0.202). The BMI≥35 group received more new medication and/or dose adjustments (74% vs 66%, p = 0.016). Only 29% in the BMI≥35kg group achieved HbA1c < 53 mmol/mol (7.0%).Conclusions In spite of frequently meeting the criteria for bariatric surgery and not achieving glycaemic targets, people with T2DM in this specialist clinic received limited medical or surgical management of their obesity. Our data support the need to prioritise obesity management in the treatment of type 2 diabetes.

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