Obesity is now recognized as one of the leading causes of many diseases. There are also other impor-tant factors to consider, such as the medical costs associated with obesity and obesity-related comorbidities. “It’s essential to improve our treatment strategies for managing obesity so that we can effectively reduce the rate of obesity-related conditions, most notably type 2 diabetes,” says Louis J. Aronne, MD, FACP.
Shifting the Approach
According to Dr. Aronne, much of the focus on managing patients with diabetes is to get A1C levels within a normal range. “While this is an important part of caring for patients with diabetes, it’s also paramount that clinicians recognize that many commonly used diabetes therapies can cause weight gain as a side effect,” he says. Patients can gain a significant amount of weight in a relatively short period after initiating diabetes medications. Drug-induced weight gain can have many consequences, including patient non-compliance with treatment regimens once weight gain occurs and health complications associated with weight gain itself.
“If patients gain weight from taking their diabetes drugs,” Dr. Aronne says, “it’s possible that this can mitigate control of their diabetes. Although effective glucose control remains important, it cannot come at the expense of worsening obesity. A paradigm shift is needed in which physicians use a weight-centric approach to managing diabetes rather than a glucose-centric model.” Even modest weight loss can improve multiple cardiovascular risk factors while simultaneously improving glycemic control.
Published guidelines have supported the concept of shifting treatment plans for diabetes toward a weight-centric approach. “Weight loss via lifestyle modifications and pharmacotherapy are now encouraged earlier in the treatment of diabetes and prediabetes,” says Dr. Aronne. Lifestyle changes and weight loss pharmacotherapies can promote improvement in diabetes as well as many other obesity-related conditions.
On the Horizon
Pharmaceutical companies are continuing to develop and test medications for the treatment of obesity, and some drugs currently used to treat type 2 diabetes have been shown to help promote weight loss. In addition, several investigational medications and combination drugs in the pipeline may potentially help promote weight loss further. “Physicians should strive to use medications that either promote weight loss or are weight neutral when treating patients with diabetes,” Dr. Aronne says. “Eating too much and exercising too little are clearly involved in weight gain, but many patients with diabetes comply with lifestyle recommendations and don’t achieve the desired results. For these patients, clinicians should examine their medication regimen and seek alternative pharmacologic therapies that can either promote weight loss or are weight neutral.”
Readings & Resources (click to view)
Igel LI, Powell AG, Apovian CM, Aronne LJ. Advances in medical therapy for weight loss and the weight-centric management of type 2 diabetes mellitus. Curr Atheroscler Rep. 2012;14:60-69. Available at: http://link.springer.com/article/10.1007%2Fs11883-011-0221-0.
Wright SM, Aronne LJ. Obesity in 2010: the future of obesity medicine: where do we go from here? Nat Rev Endocrinol. 2011;7:69-70.
Aronne LJ, Wadden T, Isoldi KK, Woodworth KA. When prevention fails: obesity treatment strategies. Am J Med. 2009;122(Suppl 1):S24-S32.
Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545-2559.
Siram AT, Yanagisawa R, Skamagas M. Weight management in type 2 diabetes mellitus. Mount Sinai J Med. 2010;77:533-448.
The Look AHEAD Research Group. Long term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes: four year results of the Look AHEAD trial. Arch Intern Med. 2010;170:1566-1575.