The Weight Problem in Type 2 Diabetes and How Best to Tackle It

The Weight Problem in Type 2 Diabetes and How Best to Tackle It

Lange Virginia Zamudio
US Endocrinology Volume 4 Issue 1
Published: November 2009
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Weight, body mass index (BMI), and distribution of body fat are three of the core issues in type 2 diabetes. Weight gain,1 a high BMI,2 and central obesity3 are all risk factors for the development of this condition and its comorbidities, such as vascular complications and organ damage.4,5 The majority of individuals with type 2 diabetes are overweight, many at the time of diagnosis.6 These patients can often experience additional metabolic abnormalities, leading to further decreases in glycemic control and worsening of diabetes symptoms.7 Diabetes, obesity, dyslipidemia, and hypertension frequently occur in the same individual in a cluster of conditions collectively known as the metabolic syndrome.8

Weight loss in obese individuals has been shown to delay the onset of diabetes.9 In those who have already developed type 2 diabetes, metabolic control can be improved if weight is reduced.10,11 Properly managed lifestyle interventions such as exercise and diet plans are highly effective, and are considered as part of first-line therapy.12 This requires careful planning: according to the American Diabetes Association (ADA), standard weightreduction diets (controlled at 500–1000 fewer calories per day than normal) do not work when used alone.13 Intensive programs of lifestyle modification that include a low-calorie, low-fat diet, structured physical activity, and oneon- one educational sessions—such as that used by the Diabetes Prevention Program (DPP)—can be even more effective in aiding weight loss than pharmacological intervention.9

Despite these relationships between diabetes and BMI, weight, and fat distribution, many of the traditional therapi es to treat type 2 diabetes actually result in weight gain.7 With various insulins, for example, weight gain can be in the order of 1–4kg per patient, often proportional to the correction of glycemia.12 However, it should be noted that the newer basal analog insulins such as insuline glargine and detemir are associated with lower weight gain compared with traditional insuins. Nevertheless, as glycemic control is improved with these medications, many clinicians consider that the weight gain is an acceptable side effect. However, an increase in weight can set up an unfortunate barrier to the effective use of insulin in type 2 diabetes. Most diabetes patients are overweight already, and further weight gain may be problematic. This results in some patients deliberately not complying with their medication regimen in order to avoid such weight gain.6,14

As more types of drug become available for the treatment of type 2 diabetes, the clinician’s options will increase. Through combination of lifestyle modification, bariatric surgery, antiobesity medication, and antidiabetic medication, a patient will be able to both gain glycemic control and lose weight. This review will examine each of these options.

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Keywords:
Type 2 Diabetes Blood Sugar, Insulin Injections Type 2 Diabetes, Type 2 Diabetes Blood Glucose Levels, Type 2 Diabetes Metformin, Type 2 Diabetes Insulin Resistance, Type 1 Diabetes, Type 2 Diabetes Cure, Type 2 Diabetes Diet, Diabetes Symptoms, Type 2 Diabetes Hyperglycemia, Type 2 Diabetes Symptoms, HBA1C Type 2 Diabetes, Blood Glucose Monitoring Type 2 Diabetes

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