Divide and Conquer: The Multidisciplinary Approach to Achieving Significant Long-Term Weight Loss and Improved Glycemic Control in Obese Patients With Type 2 Diabetes

Abstract

T ype 2 diabetes has become a worldwide epidemic, estimated to affect 1 in 14 adults, or 380 million people, globally by 2025.1,2 The problem is particularly acute in Australia, where the prevalence of diagnosed diabetes more than doubled between 1989 and 2005, amounting to 3 million people affected by the disease.3,4 Diabetes is the most common reason for renal dialysis, blindness in people < 60 years of age, nontraumatic lower-limb amputation, and cardiovascular disease and is the sixth-highest cause of death by disease in Australia.3,5 First-line best-practice management includes brief counseling to promote lifestyle changes in diet, exercise, and education, with the aim to improve insulin resistance, reduce hypertension, correct dyslipidemia, and achieve weight reduction.6 Patients at high risk of developing type 2 diabetes and who are refractory to lifestyle intervention may be treated with pharmacological agents and insulin, many of which contribute to further weight gain.7,8 According to several recent studies, a large proportion of newly diagnosed cases are potentially preventable or could at least be delayed through lifestyle and behavioral modification.9–11 Data from 20 longitudinal cohort studies illustrate consistently that regular physical activity substantially reduces the risk of developing type 2 diabetes by 20–30%, with the greatest benefits obtained in obese patients with impaired glucose regulation undergoing moderate- or vigorous-intensity exercise.11,12 One recent study validated a rigorous lifestyle intervention program with counseling for physical activity, nutrition, and weight loss, resulting in a risk reduction of 40–60% in adults with impaired glucose tolerance.12 Recent research supports the potential benefit of significant weight loss leading to diabetes “remission” (i.e., consistent normalization of blood glucose levels and A1C). In a pivotal study by Dixon et al.,13 73% of patients …