8. Obesity Management for the Treatment of Type 2 Diabetes:<i>Standards of Medical Care in Diabetes—2021</i>

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doi:10.2337/dc21-s008

Cited by 123 publications

(83 citation statements)

References 123 publications

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“…Since the publication of these trials, achieving remission of type 2 diabetes has been identified as a top priority by people with diabetes and their carers [ 13 ]. United Kingdom governments have recently included remission of type 2 diabetes in their long-term type 2 diabetes frameworks [ 14 , 15 ], and the American Diabetes Association (ADA) Standards of Medical Care has, for the first time, included guidance on prescribing very low calorie diets to improve glycaemic control and promote remission of diabetes [ 16 ]. The National Health Service (NHS) in England and Scotland are currently introducing the use of very low calorie diets for obese people with type 2 diabetes in routine clinical care [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study

et al. 2021

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Background Clinical pathways are changing to incorporate support and appropriate follow-up for people to achieve remission of type 2 diabetes, but there is limited understanding of the prevalence of remission in current practice or patient characteristics associated with remission. Methods and findings We carried out a cross-sectional study estimating the prevalence of remission of type 2 diabetes in all adults in Scotland aged ≥30 years diagnosed with type 2 diabetes and alive on December 31, 2019. Remission of type 2 diabetes was assessed between January 1, 2019 and December 31, 2019. We defined remission as all HbA1c values <48 mmol/mol in the absence of glucose-lowering therapy (GLT) for a continuous duration of ≥365 days before the date of the last recorded HbA1c in 2019. Multivariable logistic regression in complete and multiply imputed datasets was used to examine characteristics associated with remission. Our cohort consisted of 162,316 individuals, all of whom had at least 1 HbA1c ≥48 mmol/mol (6.5%) at or after diagnosis of diabetes and at least 1 HbA1c recorded in 2019 (78.5% of the eligible population). Over half (56%) of our cohort was aged 65 years or over in 2019, and 64% had had type 2 diabetes for at least 6 years. Our cohort was predominantly of white ethnicity (74%), and ethnicity data were missing for 19% of the cohort. Median body mass index (BMI) at diagnosis was 32.3 kg/m2. A total of 7,710 people (4.8% [95% confidence interval [CI] 4.7 to 4.9]) were in remission of type 2 diabetes. Factors associated with remission were older age (odds ratio [OR] 1.48 [95% CI 1.34 to 1.62] P < 0.001) for people aged ≥75 years compared to 45 to 54 year group), HbA1c <48 mmol/mol at diagnosis (OR 1.31 [95% CI 1.24 to 1.39] P < 0.001) compared to 48 to 52 mmol/mol), no previous history of GLT (OR 14.6 [95% CI 13.7 to 15.5] P < 0.001), weight loss from diagnosis to 2019 (OR 4.45 [95% CI 3.89 to 5.10] P < 0.001) for ≥15 kg of weight loss compared to 0 to 4.9 kg weight gain), and previous bariatric surgery (OR 11.9 [95% CI 9.41 to 15.1] P < 0.001). Limitations of the study include the use of a limited subset of possible definitions of remission of type 2 diabetes, missing data, and inability to identify self-funded bariatric surgery. Conclusions In this study, we found that 4.8% of people with type 2 diabetes who had at least 1 HbA1c ≥48 mmol/mol (6.5%) after diagnosis of diabetes and had at least 1 HbA1c recorded in 2019 had evidence of type 2 diabetes remission. Guidelines are required for management and follow-up of this group and may differ depending on whether weight loss and remission of diabetes were intentional or unintentional. Our findings can be used to evaluate the impact of future initiatives on the prevalence of type 2 diabetes remission.

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Section: Introductionmentioning

confidence: 99%

Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study

et al. 2021

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“…Weight loss of at least 5% of baseline level in obese patients is clinically significant and improves several obesity-related cardio-metabolical complications, such as arterial hypertension, dyslipidemia, and impaired glucose metabolism (including prediabetes and T2DM) [ 10 , 11 , 12 ]. Pharmacological treatment is generally recommended in patients who did not present significant improvement after lifestyle modifications and BMI ≥ 30 kg/m 2 or ≥27 kg/m 2 , with excess weight-associated comorbidities such as diabesity [ 1 , 13 , 14 ]. Currently approved anti-obesity drugs are illustrated in Table 1 .…”

Section: Introductionmentioning

confidence: 99%

“…GLP-1 RAs and sodium-glucose co-transporter type 2 (SGLT-2) inhibitors are usually the class of drugs preferred in managing diabesity in association with metformin due to their association with weight loss [ 13 , 15 ]. In the present article, we aim to review and highlight the existing literature on the effects of liraglutide in managing diabesity and excess-weight individuals without diabetes, emphasizing its role as a lower-glucose therapy with benefits on cardiovascular outcomes, weight reduction, and quality of life.…”

Section: Introductionmentioning

confidence: 99%

A 2021 Update on the Use of Liraglutide in the Modern Treatment of ‘Diabesity’: A Narrative Review

et al. 2021

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Obesity and type 2 diabetes mellitus have become a significant public health problem in the past decades. Their prevalence is increasing worldwide each year, greatly impacting the economic and personal aspects, mainly because they frequently coexist, where the term “diabesity” may be used. The drug class of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) is one of the most modern therapy options in managing these metabolic disorders. This review focuses on the effects of liraglutide, a long-acting GLP-1 RA, in diabesity and non-diabetic excess weight. This drug class improves glycemic control by enhancing insulin secretion from the beta-pancreatic cells and inhibiting glucagon release. Furthermore, other effects include slowing gastric emptying, increasing postprandial satiety, and reducing the appetite and food consumption by influencing the central nervous system, with weight reduction effects. It also reduces cardiovascular events and has positive effects on blood pressure and lipid profile. A lower-dose liraglutide (1.2 or 1.8 mg/day) is used in patients with diabetes, while the higher dose (3.0 mg/day) is approved as an anti-obesity drug. In this review, we have summarized the role of liraglutide in clinical practice, highlighting its safety and efficacy as a glucose-lowering agent and a weight-reduction drug in patients with and without diabetes.

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“…Current nutritional treatment guidelines for adults with type 2 diabetes focus on improving glycemic control, body weight management and cardiovascular risk factors. Although these guidelines emphasize individualized nutritional therapy, recommendations generally promote healthy whole foods with high fiber content and low added sugars and refined grains [7,8]. With regard to NAFLD, dietary recommendations mostly follow guidelines for adults with obesity and/or type 2 diabetes with a focus on energy restriction and diet quality [9,10].…”

Section: Introductionmentioning

confidence: 99%

Improving insulin sensitivity, liver steatosis and fibrosis in type 2 diabetes by a food-based digital education-assisted lifestyle intervention program: a feasibility study

et al. 2021

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Purpose Recent trials demonstrated remission of type 2 diabetes and non-alcoholic fatty liver disease (NAFLD) following formula diet-induced weight loss. To improve the outreach for populations in need, many mobile health apps targeting weight loss have been developed with limited scientific evaluation of these apps. The present feasibility study investigated the effects of a novel approach incorporating a regular ‘whole food-based’ low-calorie diet combined with app-based digital education and behavioral change program on glucose metabolism and disease management. Methods Twenty-four individuals with type 2 diabetes followed this approach supported by weekly coaching calls for 12 weeks. Phenotyping included bioimpedance analysis, mixed-meal tolerance test, magnetic resonance spectroscopy and transient elastography for assessing liver fat content and liver stiffness. Results Over 12 weeks, participants reduced their body weight by 9% (97 ± 13 to 88 ± 12 kg), body mass index (BMI; 33 ± 5 to 29 ± 4 kg/m2), total fat mass (31 ± 10 to 27 ± 10%) (all p < 0.01) and liver fat by 50% alongside with decreased liver stiffness. Target HbA1c (< 6.5%) was achieved by 38% and resolution of NAFLD (liver fat content < 5.6%) was observed in 30% of the participants. Conclusion This novel approach combining digital education with a low-calorie diet results in effective improvements of body weight, glycemic control and NAFLD and could complement existing care for patients with type 2 diabetes. Trial registration NCT04509245

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8. Obesity Management for the Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2021

Cited by 123 publications

References 123 publications

Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study

Epidemiology of type 2 diabetes remission in Scotland in 2019: A cross-sectional population-based study

A 2021 Update on the Use of Liraglutide in the Modern Treatment of ‘Diabesity’: A Narrative Review

Improving insulin sensitivity, liver steatosis and fibrosis in type 2 diabetes by a food-based digital education-assisted lifestyle intervention program: a feasibility study

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