Abstract
The prevalence of obesity has increased to pandemic levels worldwide and is related to increased risk of morbidity and mortality. Metabolic comorbidities are commonly associated with obesity and include metabolic syndrome, pre-diabetes, and type 2 diabetes. Even if the prevalence of obesity remains stable until 2030, the anticipated numbers of people with diabetes will more than double as a consequence of population aging and urbanization. Weight reduction is integral in the prevention of diabetes among obese adults with pre-diabetes. Lifestyle intervention and weight reduction are also key in the management of type 2 diabetes. Weight loss is challenging for most obese patients, but for those with diabetes, it can pose an even greater challenge due to the weight gain associated with many treatment regimens. This article will review optimal treatment strategies for patients with comorbid obesity and type 2 diabetes. The role of anti-obesity agents in diabetes will also be reviewed. This literature review will provide readers with current strategies for the pharmacologic treatment of obesity and diabetes with a focus on the weight outcomes related to diabetes treatments.
Highlights
Excess body fat or obesity defined as a body mass index (BMI) ≥ 30 kg/m2, is an important factor in the pathogenesis of insulin resistance and substantially increases the risk of type 2 diabetes
Glucose homeostasis is a complex interplay of multiple hormones: insulin and amylin produced by the beta cells, glucagon produced by pancreatic alpha cells and the incretin hormones; glucagon-like peptide 1 (GLP-1) and glucose insulinotropic polypeptide (GIP), and dipeptidyl peptidase-4
Due to minimal efficacy and the need for frequent injection, pramlintide is not recommended as first line therapy by the ADA or European Association for the Study of Diabetes (EASD), but because of its positive effects on weight and the reduced insulin requirements, it may be considered as an option for obese type 2 diabetic patients that use mealtime insulin [17]
Summary
Excess body fat or obesity defined as a body mass index (BMI) ≥ 30 kg/m2, is an important factor in the pathogenesis of insulin resistance and substantially increases the risk of type 2 diabetes. In obese patients with diagnosed type 2 diabetes, weight reduction of 5%–10% from baseline can lead to improved glucose control as well as improvements in blood pressure and cholesterol [1]. Newly approved medications in the treatment of obesity can lead to improvements in glucose control in those with diabetes. Overweight status and obesity fuel the global diabetes epidemic and if current trends continue, the number of overweight people (BMI ≥ 25 kg/m2) is projected to increase from 1.3 billion in 2005 to nearly 2.0 billion by 2030 [3]. Estimates suggest that by 2030, diabetes will affect 438 million people worldwide These increases are thought to be in part due to increases in nutrition transitions and decreases in physical activity promoting positive energy balance. Rapid urbanization and transitions in nutritional status has led to Asia accounting for 60% of the world’s diabetic population [4,5]
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