management of obese subjects with type 2 diabetes.
The management of the obese diabetic patient should combine strategies which aim at reducing weight excess, lowering chronic hyperglycaemia and correcting other risk factors. Weight loss is a major target in treating obese patients with type 2 diabetes as it allows simultaneous improvement in both glycaemic control and associated risk factors, whereas specific anti-hyperglycaemic treatment, with sulphonylureas or insulin (but not metformin), usually favours weight gain and may worsen the risk profile. Aggressive weight reduction programmes may be used in severely obese individuals with type 2 diabetes, refractory to conventional diet and drug treatment. In particular, bariatric surgery may be helpful in diabetic subjects with morbid obesity. However, even if weight loss appears to be the cornerstone of successful treatment, long-term prospective studies are still required to determine more precisely the place of each strategy in the overall management of obese diabetic patients (evidence-based medicine). Obviously, the prevention of obesity should be considered a key objective by medical practitioners and public health authorities in order to limit the expected epidemic of type 2 diabetes mellitus in this early new millennium.
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