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From Research to Practice

Treatment of Obesity in Patients With Diabetes

  1. Carolyn T. Bramante1,
  2. Clare J. Lee2 and
  3. Kimberly A. Gudzune1,3
  1. 1Division of General Internal Medicine
  2. 2Division of Endocrinology, Diabetes, and Metabolism, and
  3. 3The Welch Center for Prevention, Epidemiology and Clinical Research, The John Hopkins University, Baltimore, MD
  1. Corresponding author: Carolyn T. Bramante, cb{at}jhmi.edu
Diabetes Spectrum 2017 Nov; 30(4): 237-243. https://doi.org/10.2337/ds17-0030
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Article Figures & Tables

Tables

  • TABLE 1.

    Weight-Related Complications Caused/Exacerbated by Excess Adiposity (2)

    • Elevated blood pressure• Reactive airway disease
    • Hypertriglyceridemia• Nonalcoholic fatty liver disease
    • Hypercholesterolemia• Gastroesophageal reflux disease
    • Decreased HDL cholesterol• Male hypogonadism
    • Osteoarthritis• Female infertility
    • Depression• Polycystic ovary disease
    • Sleep apnea• Stress urinary incontinence
  • TABLE 2.

    The 5 A’s Model for Behavior Change and Its Use for Weight Management in Practice (22)

    1. Assess• Assess patients for obesity or overweight with metabolic risk factors
    • Assess for patients’ readiness and ability to make change at this time
    2. Advise• Advise patients about the increased risks of cardiovascular disease with excess adiposity
    • Advise patients of the health benefits of weight loss and lifestyle change
    3. Agree• Agree with patients on a quantifiable and achievable weight loss goal that will lead to health benefits (i.e., a goal of losing 5% of initial body weight in 6 months)
    4. Assist• Assist patients in defining a weight management strategy (i.e., practice-based weight loss counseling vs. referral to a weight loss program)
    5. Arrange• Arrange follow-up to create a structure for accountability and feedback on progress
  • TABLE 3.

    Common Commercial Weight Loss Programs’ Weight Loss and Glycemic Outcomes In RCTs

    Time PointMean Weight Loss at Time Point (kg)RCTs Conducted in Patients With Diabetes?A1C Change at Time Point (%)Patients Who Reduced Diabetes Medications at Time Point (%)
    Weight Watchers12 Months–3.0 to – 9.1No——
    Jenny Craig12 Months–6.6 to –10.1Yes–0.3 to –0.730–39 (oral); 63–90 (insulin)
    Nutrisystem6 Months–7.3 to –10.8Yes–0.728 (all medications)
  • TABLE 4.

    Eating Patterns With Equivalent Effects on Weight Loss (2)

    • Low glycemic index/load• Low carbohydrate
    • High protein• Moderate carbohydrate–moderate protein
    • Low fat• Mediterranean style
  • TABLE 5.

    Medications Approved by the FDA for Long-Term Use for Weight Management

    Medication (Trade Names)Mechanism of ActionFive Most Common Side EffectsPossible Safety Concerns*Mean 1-Year Weight Loss Compared to Placebo (Dose)A1C Change in Patients With Diabetes (%)
    Decreases absorption
    Orlistat (Alli, Xenical)Lipase inhibitorAbdominal pain, flatulence, fecal urgency, back pain, and headacheFat-soluble vitamin deficiencies, altered absorption of medications, cholelithiasis, nephrolithiasis3.4 kg, 4.0% (120 mg TID)–0.7
    Suppresses appetite
    Lorcaserin (Belviq)Serotonin receptor agonistHeadache, nausea, dizziness, fatigue, and nasopharyngitisSerotonin syndrome, hypertension, edema, avoid in liver and renal failure3.3 kg, 3.6% (10 mg BID)–1.1†
    Phentermine/Topiramate (Qsymia)Norepinephrine release, GABA receptor modulationConstipation, paresthesia, insomnia, nasopharyngitis, and xerostomiaBirth defects, cognitive impairment, acute angle-closure glaucoma, lactic acidosis with metformin, avoid in renal failure6.7 kg, 6.6% (7.5/46 mg daily) 8.9 kg, 9.0% (15/92 mg daily)–0.4
    Naltrexone/Bupropion (Contrave)Opiate antagonist, decreased re-uptake of norepinephrineConstipation, nausea, headache, xerostomia, and insomniaDepression, anxiety, acute angle-closure glaucoma, avoid in patients with uncontrolled hypertension and renal failure4.1 kg, 5.2% (16/80 mg BID)–0.6
    Liraglutide (Saxenda)GLP-1 receptor agonistHypoglycemia, constipation, nausea, headache, and indigestionGastroparesis, suicidal ideation, increased heart rate, caution in pancreatitis and cholelithiasis4.5 kg, 5.6% (3 mg daily)–0.6 to –1.8
    • ↵* A comprehensive list of safety concerns can be found in each medication’s package insert, which is available from the manufacturing pharmaceutical company.

    • ↵† A1C change has only been assessed in patients with prediabetes (66).

    • BID, twice daily; GABA, gamma-aminobutyric acid; TID, three times daily.

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Diabetes Spectrum: 30 (4)

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Treatment of Obesity in Patients With Diabetes
Carolyn T. Bramante, Clare J. Lee, Kimberly A. Gudzune
Diabetes Spectrum Nov 2017, 30 (4) 237-243; DOI: 10.2337/ds17-0030

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Treatment of Obesity in Patients With Diabetes
Carolyn T. Bramante, Clare J. Lee, Kimberly A. Gudzune
Diabetes Spectrum Nov 2017, 30 (4) 237-243; DOI: 10.2337/ds17-0030
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  • About Medha N. Munshi, MD: Guest Editor, Management of Diabetes Across the Life Spectrum
  • Challenges and Strategies for Managing Diabetes in the Elderly in Long-Term Care Settings
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