Weight Management in Diabetes

Canadian Diabetes Association Clinical Practice Guidelines Expert Committee

Sean Wharton MD, FRCPC, PharmD Arya M. Sharma MD, PhD, FRCPC David C.W. Lau MD, PhD, FRCPC

  • Key Messages
  • Recommendations
  • Figures
  • Highlights
  • Full Text
  • References

Key Messages

  • An estimated 80% to 90% of persons with type 2 diabetes are overweight or obese. Higher body mass index in people with diabetes is associated with increased overall mortality.
  • A modest weight loss of 5% to 10% of initial body weight can substantially improve glycemic control and cardiovascular disease risk factors.
  • Comprehensive health behaviour intervention should be implemented in overweight and obese people with diabetes or those at risk for diabetes to prevent weight gain and to achieve and maintain a reduced body weight. Many classes of antihyperglycemic medications are associated with weight gain, while some are weight neutral or associated with weight loss. The drug effects on body weight should be considered in glycemic management.
  • Bariatric surgery may be considered for appropriate patients when other interventions fail to achieve and maintain a healthy body weight.

Highlights of Revisions

  • Chapter title has been changed from "Management of Obesity in Diabetes" to "Weight Management in Diabetes" to more accurately depict the content of the chapter, which focuses on the importance of a healthy weight for all individuals living with diabetes and not just those with an obese body mass index (BMI).
  • Practitioners are reminded to consider the weight effects of antihyperglycemic agents when selecting the most appropriate agent for an individual.
  • A series of bariatric surgery illustrations has been added to the chapter to provide physicians with a more detailed description of each type of surgery.

Recommendations

  1. 1.An interdisciplinary weight management program (including a nutritionally balanced, calorie-restricted diet; regular physical activity; education; and counselling) for overweight and obese people with, or at risk for, diabetes should be implemented to prevent weight gain and to achieve and maintain a lower, healthy body weight [Grade A, Level 1A (1,2) ].
  2. 2.In overweight or obese adults with type 2 diabetes, the effect of antihyperglycemic agents on body weight should be taken into account [Grade D, Consensus].
  3. 3.Adults with type 2 diabetes and class II or III obesity (BMI ≥35.0 kg/m2) may be considered for bariatric surgery when lifestyle interventions are inadequate in achieving healthy weight goals [Grade B, Level 2 (3–5)].

References

  1. Look AHEAD Research Group, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 2010;170:1566-75.
  2. Diabetes Program Prevention Research Group. Reduction in the incidence of Type 2 diabetes with lifestyle or metformin. N Eng J Med 2002;346:393-403.
  3. Mingrone G, Panunzi S, De Gaetano A, et al. Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 2012;366:1577-85.
  4. Schauer PR, Kashyap SR,Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 2012;366:1567-76.
  5. Abbatini F, Rizzello M, Casella G, et al. Long-term effects of laparoscopic sleeve gastrectomy, gastric bypass, and adjustable gastric banding on type 2 diabetes. Surg Endosc 2010;24:1005-10.

 

Reproduced with permission from Canadian Journal of Diabetes © 2013 Canadian Diabetes Association. To cite this article, please refer to For citation.

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