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Obesity management
#1
Obesity management for treatment of type 2 diabetes
 
There is strong and consistent evidence that obesity management can delay progression from prediabetes to type 2 diabetes (1,2) and may be beneficial in the treatment of type 2 diabetes. In overweight and obese patientswith type 2 diabetes,modest and sustained weight loss has been shown to improve glycemic control and to reduce the need for glucose-lowering medications (3–5). Small studies have demonstrated that in obese patients with type 2 diabetes more extreme dietary energy restriction with very low-calorie diets can reduce A1C to ,6.5% (48 mmol/mol) and fasting glucose to ,126 mg/dL (7.0 mmol/L) in the absence of pharmacological therapy or ongoing procedures   . Weight loss–induced improvements in glycemia are most likely to occur early in the natural history of type 2 diabetes when obesity associated insulin resistance has caused reversible b-cell dysfunction but insulin secretory capacity remains relatively preserved (5). Although the Action for Health in Diabetes (Look AHEAD) trial did not show that an intensive lifestyle intervention reduced cardiovascular events in overweight or obese adults with type 2 diabetes  . it did show the feasibility of achieving and maintaining long-term weight loss in patients with type 2 diabetes.

LOOK AHEAD
In the Look AHEAD intensive lifestyle intervention group,mean weight losswas 4.7% (SE 0.2) at 8 years . Approximately 50% of intensive lifestyle intervention participants lost $5% and 27% lost $10% of their initial body weight at 8 years.Participants randomly assigned to the intensive lifestyle group achieved equivalent risk factor control but required fewer glucose-, blood pressure–, and lipid-lowering medications than those randomly assigned to standard care. Secondary analyses of the Look AHEAD trial and other large cardiovascular outcome studies document other benefits of weight loss in patients with type 2 diabetes, including improvements in mobility, physical and sexual functioning, and health-related quality of life /.The goal of this section is to provide evidence-based recommendations for dietary, pharmacological, and surgical interventions for obesity management as treatments for hyperglycemia in type 2 diabetes
 
 References : 
1. Clement S, Braithwaite SS, Magee MF, et al.;American Diabetes Association Diabetes in Hospitals Writing Committee. Management of diabetes and hyperglycemia in hospitals. Diabetes Care 2004;27:553–591
2. Moghissi ES, Korytkowski MT, DiNardo M,et al.; American Association of Clinical Endocrinologists;American Diabetes Association.American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care 2009;32:1119–1131
3. Institute of Medicine. Preventing Medication Errors. Aspden P, Wolcott J, Bootman JL,Cronenwett LR, Eds. Washington, DC, The National Academies Press, 2007
4. Gillaizeau F, Chan E, Trinquart L, et al. Computerized advice on drug dosage to improve prescribing practice. Cochrane Database Syst Rev 2013;11:CD002894
5. Wexler DJ, Shrader P, Burns SM, Cagliero E.Effectiveness of a computerized insulin ordertemplate in general medical inpatients withtype 2 diabetes: a cluster randomized trial. DiabetesCare 2010;33:2181–2183
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#2
(09-20-2016, 05:48 AM)Dr_vaziri.ziba Wrote: Obesity management for treatment of type 2 diabetes
 
There is strong and consistent evidence that obesity management can delay progression from prediabetes to type 2 diabetes (1,2) and may be beneficial in the treatment of type 2 diabetes. In overweight and obese patientswith type 2 diabetes,modest and sustained weight loss has been shown to improve glycemic control and to reduce the need for glucose-lowering medications (3–5). Small studies have demonstrated that in obese patients with type 2 diabetes more extreme dietary energy restriction with very low-calorie diets can reduce A1C to ,6.5% (48 mmol/mol) and fasting glucose to ,126 mg/dL (7.0 mmol/L) in the absence of pharmacological therapy or ongoing procedures   . Weight loss–induced improvements in glycemia are most likely to occur early in the natural history of type 2 diabetes when obesity associated insulin resistance has caused reversible b-cell dysfunction but insulin secretory capacity remains relatively preserved (5). Although the Action for Health in Diabetes (Look AHEAD) trial did not show that an intensive lifestyle intervention reduced cardiovascular events in overweight or obese adults with type 2 diabetes  . it did show the feasibility of achieving and maintaining long-term weight loss in patients with type 2 diabetes.

LOOK AHEAD
In the Look AHEAD intensive lifestyle intervention group,mean weight losswas 4.7% (SE 0.2) at 8 years . Approximately 50% of intensive lifestyle intervention participants lost $5% and 27% lost $10% of their initial body weight at 8 years.Participants randomly assigned to the intensive lifestyle group achieved equivalent risk factor control but required fewer glucose-, blood pressure–, and lipid-lowering medications than those randomly assigned to standard care. Secondary analyses of the Look AHEAD trial and other large cardiovascular outcome studies document other benefits of weight loss in patients with type 2 diabetes, including improvements in mobility, physical and sexual functioning, and health-related quality of life /.The goal of this section is to provide evidence-based recommendations for dietary, pharmacological, and surgical interventions for obesity management as treatments for hyperglycemia in type 2 diabetes
 
 References : 
1. Clement S, Braithwaite SS, Magee MF, et al.;American Diabetes Association Diabetes in Hospitals Writing Committee. Management of diabetes and hyperglycemia in hospitals. Diabetes Care 2004;27:553–591
2. Moghissi ES, Korytkowski MT, DiNardo M,et al.; American Association of Clinical Endocrinologists;American Diabetes Association.American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care 2009;32:1119–1131
3. Institute of Medicine. Preventing Medication Errors. Aspden P, Wolcott J, Bootman JL,Cronenwett LR, Eds. Washington, DC, The National Academies Press, 2007
4. Gillaizeau F, Chan E, Trinquart L, et al. Computerized advice on drug dosage to improve prescribing practice. Cochrane Database Syst Rev 2013;11:CD002894
5. Wexler DJ, Shrader P, Burns SM, Cagliero E.Effectiveness of a computerized insulin ordertemplate in general medical inpatients withtype 2 diabetes: a cluster randomized trial. DiabetesCare 2010;33:2181–2183
This is very informative. Thanks for sharing .
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#3
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