Home / Health / Experts discuss the best approach to treating type 2 diabetes in obesity

Experts discuss the best approach to treating type 2 diabetes in obesity



LAS VEGAS – If a person is suffering from obesity with type 2 diabetes, the clinician should first focus on lowering blood sugar rather than on body weight to reduce end-organ complications that affect quality of life increase the risk of dying a speaker at ObesityWeek.

Randomized controlled trials suggest that intensive interventions in lifestyle and obesity medications can improve body weight and HbA1c in a person with type 2 diabetes and obesity. Jack Leahy, MD, Professor of Medicine and The head of the Department of Endocrinology, Diabetes and Metabolism at the University of Vermont College of Medicine in Burlington and the director of the Vermont Regional Diabetes Center gave during a debate on the optimal treatment of diabetes in patients with obesity. However, practice studies show that these benefits do not always apply to the person in the clinic who is prescribed such therapies.

"The average patient with a chronic condition goes to his family doctor and is watched for a moderate amount of time and receives a prescription for one or more medications," said Leahy. "This works for the diabetes approach, but with an obesity-medical approach, it can not be done that way, it's person-intensive, time-consuming, and I do not know how to translate that into the real world."

The "main goal" for People with obesity and type 2 diabetes are able to keep the person alive and well to prevent complications with endocrine diabetics, Leahy said ̵

1; and diabetes medications such as SGLT2 inhibitors and GLP-1 receptor agonists will make these targets more efficient achieve this as lifestyle modifications or weight loss drugs.

"To achieve this, we focus on optimizing HbA1c," said Leahy. "There is no debate for me to correct blood sugar, and then we'll take care of it about the weight. "

  Diabetes and Fruits 2019

If a person is overweight on type 2 diabetes, the attending physician should first focus on lowering blood sugar and not focus on body weight to reduce end-organ complications that affect quality of life and increase the risk of death.

Source: Adobe Stock

An "adipose" approach

The diseases of type 2 diabetes and obesity are closely related, W. Timothy Garvey, MD, FACE, Professor of Medicine and Chair of the Department of Nutritional Sciences at the University of Alabama in Birmingham, said during his part of the debate.

One focus on diabetes, Garvey said, will address hyperglycemia, but no treatment for obesity. It can not optimally prevent or alleviate the effects of obesity on health, quality of life, biomechanical complications and cardiometabolic disorders. Weight loss therapy, however, will treat the entire patient with obesity and improve blood sugar levels with less need for traditional diabetes medications.

"What if there was a magic pill for diabetes that lowered HbA1c by 0.5% to 1.6%? At the same time, diabetes reduced medications, caused a 5-15% reduction in body weight, lowered blood pressure, reduced triglycerides, increased HDL cholesterol, got liver fat, was renoprotective, improved sleep apnea, improved mobility, reduced pain, and better quality of life ? "Garvey asked. "There is no diabetes drug that gives you this therapeutic profile, and this is the therapeutic profile of weight loss in type 2 diabetes." the tools for physicians and health professionals in obesity medicine. This includes lifestyle interventions, medications and bariatric surgeries. Data from the Clinical Diabetes Relief Study (DIRECT), which examined whether intensive routine weight management would induce remission of type 2 diabetes, showed that 46% of participants in the intervention group and 4% A diabetes remission was achieved% of participants in the control group, Garvey said. Diabetes remission was even higher among participants who lost 15% of their body weight.

"There is no diabetes drug that does this," Garvey said.
Similarly, weight loss drugs such as extended release phentermine / topiramate (Qsymia, Vivus), lorcaserin (Belviq, Eisai), naltrexone / bupropion ER (Contrave, Nalpropion Pharmaceuticals), and liraglutide 3 mg (Saxenda, Novo Nordisk) are associated with an improved glycemic response and reduced need for diabetes medication, Garvey said. Even bariatric interventions such as the Roux-en-Y gastric bypass are accompanied by a diabetes remission and reduced cardiometabolic complications.

Advantages of Diabetes Drugs

Diabetes medications, especially SGLT2 inhibitors and GLP-1 receptor agonists, are also associated with significant weight loss, are easy to take in oral form, have minimal side effects and low risk for Leahy's hypoglycaemia. With SGLT2 inhibitors, a person with obesity and diabetes can already achieve cardioprotective benefit after 6 weeks, he said.

In the groundbreaking Look AHEAD study, a long-term, intense lifestyle weight-loss intervention in more than 5,100 adults with type 2 diabetes and overweight or obesity, weight-loss was modest and participants saw no reduction in CV events. Leahy said, including non-fatal myocardial infarction and non-fatal stroke.

"What would be better: to work hard for a lifestyle change for several years, or to take a daily SGLT-2 inhibitor that will bring benefits to you within 6 weeks?" Leahy said. "What would lead to a better quality of life?"

Nevertheless, according to Leahy, doctors in practice focus on HbA1c and body weight.

"The message of mine is not to ignore weight – not at all." Leahy said. "But you put me to the polls, and if you want to fix anything, you have to work at HbA1c." It does not sound as if everyone walking in the clinic [obesity medicine] would expect a 10% weight reduction . "

Garvey said it was important to remember that obesity is a cause of Type 2 diabetes.

" Through self-confidence, we can address problems that are complications of obesity and diabetes can also be considered a complication of obesity, "Garvey said," If you want to practice evidence-based care, do not forget about obesity medicine to help patients with obesity and diabetes deal seriously with weight loss therapy. "- by Regina Schaffer

Garvey WT et al., Debate: Management of Type 2 Diabetes – Glucose vs. Obesity-Centered Approach at: ObesityWeek 2019; 3rd to 7th November 2019; Las Vegas.

Disclosure s : Garvey reports that he has served on advisory boards for Alexion, Eisai, Merck, Novo Nordisk, Takeda, and Vivus, and research support from AstraZeneca, Elcelyx, Lexicon, Merck , Novo Nordisk, Pfizer and Weight Watchers. Leahy reports that he served as a board member for Merck and Novo Nordisk.

LAS VEGAS – When a person is suffering from obesity with type 2 diabetes, the treating physician should first focus on lowering blood sugar – not on reducing body weight End organ complications that lower quality of life and increase the mortality risk , according to a spokesman for ObesityWeek.

Randomized controlled trials suggest that intensive lifestyle interventions and obesity medications may improve the body weight and HbA1c value of a person with Type 2 diabetes and obesity, Jack Leahy, MD, Professor for Medicine and Head of the Department of Endocrinology, Diabetes and Metabolism at the University of Vermont, College of Medicine at Burlington, and director of the Vermont Regional Diabetes Center, said during a debate on the optimal treatment of diabetes in patients with obesity. However, practice studies show that these benefits do not always apply to the person in the clinic who is prescribed such therapies.

"The average patient with a chronic condition goes to his family doctor and is watched for a moderate amount of time and receives a prescription for one or more medications," said Leahy. "This works for the diabetes approach, but with an obesity-medical approach, it can not be done that way, it's person-intensive, time-consuming, and I do not know how to translate that into the real world."

The "main goal" for People with obesity and type 2 diabetes are able to keep the person alive and well to prevent complications with endocrine diabetics, Leahy said – and diabetes medications such as SGLT2 inhibitors and GLP-1 receptor agonists will make these targets more efficient achieve this as lifestyle modifications or weight loss drugs.

"To achieve this, we focus on optimizing HbA1c," said Leahy. "There is no debate for me to correct blood sugar, and then we'll take care of it about the weight. "

  Diabetes and Fruits 2019

If a person is overweight on type 2 diabetes, the attending physician should first focus on lowering blood sugar and not focus on body weight to reduce end-organ complications that affect quality of life and increase the risk of death.

Source: Adobe Stock

An "adipose" approach

The diseases of type 2 diabetes and obesity are closely related, W. Timothy Garvey, MD, FACE, Professor of Medicine and Chair of the Department of Nutritional Sciences at the University of Alabama in Birmingham, said during his part of the debate.

One focus on diabetes, Garvey said, will address hyperglycemia, but no treatment for obesity. It can not optimally prevent or alleviate the effects of obesity on health, quality of life, biomechanical complications and cardiometabolic disorders. Weight loss therapy, however, will treat the entire patient with obesity and improve blood sugar levels with less need for traditional diabetes medications.

At the same time, diabetes reduced medications, caused a 5-15% reduction in body weight, lowered blood pressure, reduced triglycerides and elevated HDL cholesterol, got liver fat, was renoprotective, improved sleep apnea, improved mobility, decreased pain and better quality of life? "Garvey asked. "There is no diabetes drug that gives you this therapeutic profile, and this is the therapeutic profile of weight loss in type 2 diabetes."

PAGE BREAK

According to Garvey, weight loss therapy is defined as expert care with all the tools available to physicians and health professionals in obesity medicine. This includes lifestyle interventions, medications and bariatric surgeries. Data from the Clinical Diabetes Relief Study (DIRECT), which examined whether intensive routine weight management would induce remission of type 2 diabetes, showed that 46% of participants in the intervention group and 4% A diabetes remission was achieved% of participants in the control group, Garvey said. Diabetes remission was even higher among participants who lost 15% of their body weight.

"There is no diabetes drug that does this," Garvey said.
Similarly, weight loss drugs such as extended release phentermine / topiramate (Qsymia, Vivus), lorcaserin (Belviq, Eisai), naltrexone / bupropion ER (Contrave, Nalpropion Pharmaceuticals), and liraglutide 3 mg (Saxenda, Novo Nordisk) are associated with an improved glycemic response and reduced need for diabetes medication, Garvey said. Even bariatric interventions such as the Roux-en-Y gastric bypass are accompanied by a diabetes remission and reduced cardiometabolic complications.

Advantages of Diabetes Drugs

Diabetes medications, especially SGLT2 inhibitors and GLP-1 receptor agonists, are also associated with significant weight loss, are easy to take in oral form, have minimal side effects and low risk for Leahy's hypoglycaemia. With SGLT2 inhibitors, a person with obesity and diabetes can already achieve cardioprotective benefit after 6 weeks, he said.

In the groundbreaking Look AHEAD study, a long-term, intense lifestyle weight-loss intervention in more than 5,100 adults with type 2 diabetes and overweight or obesity, weight-loss was modest and participants saw no reduction in CV events. Leahy said, including non-fatal myocardial infarction and non-fatal stroke.

"What would be better: to work hard for a lifestyle change for several years, or to take a daily SGLT-2 inhibitor that will bring benefits to you within 6 weeks?" Leahy said. "What would lead to a better quality of life?"

Nevertheless, according to Leahy, doctors in practice focus on HbA1c and body weight.

"The message of mine is not to ignore weight – not at all." Leahy said. "But you've voted for me, and if you want to fix anything, you have to work at HbA1c." It does not sound as if anyone walking in the [obesity medicine] clinic runs out with a 10% weight reduction . "

Garvey said it was important to remember that obesity is a driver of type 2 diabetes.

19659002]" By treating obesity with confidence, we can address the complications of obesity and diabetes, which may also be considered a complication of obesity, "said Garvey." If you want to practice evidence-based care, do not forget about obesity medicine to help patients with obesity and diabetes deal seriously with weight loss therapy – by Regina Schaffer

Garvey WT et al. Debate: Management of Type 2 Diabetes – Glucose vs. Obesity-Centered Approach. Presented at: ObesityWeek 2019; 3rd to 7th November 2019; Las Vegas.

Disclosure s : Garvey reports that he has served on advisory boards for Alexion, Eisai, Merck, Novo Nordisk, Takeda, and Vivus, and research support from AstraZeneca, Elcelyx, Lexicon, Merck , Novo Nordisk, Pfizer and Weight Watchers. Leahy reports that he served as a board member for Merck and Novo Nordisk.


Source link