Treatment of Obesity in Patients
with Type 2 Diabetes
RENA R. WING
Diabetes is a major health problem in the United States that affects approximately 16 million Americans and costs $50 billion per year. Most individuals with diabetes have type 2 diabetes (previously called “non-insulin-dependent diabetes”); approximately 60–90% of these individuals are overweight (see Chapter 84).
Weight loss is recommended for obese patients with type 2 diabetes because weight loss reduces hyperglycemia and improves abnormalities in hepatic glucose production, insulin sensitivity, and insulin secretion (see Chapter 87). Although there appears to be a dose–response relation between weight loss and improvements in glycemic control, even modest weight losses of 15–30 pounds produce long-term improvements in glycemic control.
Weight loss and maintenance are difficult to achieve in overweight patients with diabetes. In fact, recent data from a variety of weight loss interventions suggest that weight loss and maintenance may be an even greater problem for diabetic than for nondiabetic individuals. Efforts are therefore needed to develop more effective interventions for these patients.
WITH TYPE 2 DIABETES
For the most part, weight loss strategies for obese patients with diabetes parallel those used with nondiabetics and involve a combination of diet, exercise, and behavior modification (see Chapters 93 and 94). This section highlights some of the differences in the treatment of diabetic versus nondiabetic individuals.