Skip to main content
SpringerLink
Log in

Treating diabetes and prediabetes by focusing on obesity management

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Obesity is associated with an increased risk of developing insulin resistance and type 2 diabetes mellitus (T2DM). In obesity, the adipose cell releases non-esterified free fatty acids, hormones, adipocytokines, and other substances that are involved in insulin resistance. Under normal conditions, the pancreatic islet β cells increase production of insulin sufficiently to maintain normal blood glucose concentrations despite insulin resistance. However, in genetically predisposed patients, the β cells eventually become dysfunctional and T2DM develops. The development of T2DM can be delayed or sometimes prevented in individuals with obesity who are able to lose weight. Weight loss can be achieved medically with behavioral therapies that combine diet and exercise treatment or with behavioral therapies combined with weight-loss medications or weight-loss surgery. In this article, we summarize the evidence of obesity management in treating T2DM and prediabetes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Schauer PR, Burguera B, Ikramuddin S, et al.: Effect of laparoscopic Roux-en gastric bypass on type 2 diabetes mellitus. Ann Surg 2003, 238:467–484.

    PubMed  Google Scholar 

  2. Sugarman HJ, Wolfe LG, Sica DA, Clore JN: Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg 2003, 237:751–756.

    Article  Google Scholar 

  3. Adams D, Gress RE, Smith MA, et al.: Long-term mortality after gastric bypass surgery. N Engl J Med 2007, 357:753–761.

    Article  PubMed  CAS  Google Scholar 

  4. Kahn BB, Flier JS: Obesity and insulin resistance. J Clin Invest 2000, 106:473–481.

    Article  PubMed  CAS  Google Scholar 

  5. Friedman JM: Obesity in the new millennium. Nature 2000, 404:632–634.

    PubMed  CAS  Google Scholar 

  6. Fischer S, Hanefeld M, Haffner SM, et al.: Insulin-resistant patients with type 2 diabetes mellitus have higher serum leptin levels independently of body fat mass. Acta Diabetol 2002, 39:105–110.

    Article  PubMed  CAS  Google Scholar 

  7. Golay A, Defronzo RA, Thorin D, et al.: Glucose disposal in obese non-diabetic and diabetic type II patients. A study by indirect calorimetry and euglycemic insulin clamp. Diabete Metab 1988, 14:443–451.

    PubMed  CAS  Google Scholar 

  8. Wing RR, Blair EH, Bononi P, et al.: Caloric restriction per se is a significant factor in improvements in glycemic control and insulin sensitivity during weight loss in obese NIDDM patients. Diabetes Care 1994, 17:30–36.

    Article  PubMed  CAS  Google Scholar 

  9. Agurs-Collins TD, Have TR, Kumanyika SK, et al.: A randomized controlled trial of weight reduction and exercise for diabetes management in older African-American subjects. Diabetes Care 1997, 20:1503–1511.

    Article  PubMed  CAS  Google Scholar 

  10. Heller SR, Clarke P, Daly H, et al.: Group education for obese patients with type 2 diabetes: greater success at less cost. Diabet Med 1998, 5:552–556.

    Article  Google Scholar 

  11. Mancini M, Di Biase G, Contaldo F, et al.: Medical complications of severe obesity: importance of treatment by very-low calorie diets. Intermediate and long-term effects. Int J Obes Relat Metab Disord 1981, 5:341–352.

    CAS  Google Scholar 

  12. Watt NB, Spanheimer RG, DiGirolamo M, et al.: Prediction of glucose response to weight loss in patients with non-insulin dependent diabetes mellitus. Arch Intern Med 1990, 150:803–806.

    Article  Google Scholar 

  13. Jazet I, Schaart G, Gastaldelli A, et al.: Loss of 50% of excess weight using a very low energy diet improves insulin-stimulated glucose disposal and skeletal muscle insulin signalling in obese insulin-treated type 2 diabetic patients. Diabetologia 2008, 51:309–319.

    Article  PubMed  CAS  Google Scholar 

  14. Feldstein AC, Nichols GA, Smith DH, et al.: Weight change in diabetes and glycemic and blood pressure control. Diabetes Care 2008, 31:1960–1965.

    Article  PubMed  Google Scholar 

  15. Tuomilehto J, Lindstrom J, Eriksson JG, et al.: Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001, 344:1343–1350.

    Article  PubMed  CAS  Google Scholar 

  16. Knowler WC, Barrett-Connor E, Fowler SE, et al.: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002, 346:393–403.

    Article  PubMed  CAS  Google Scholar 

  17. American Diabetes Association: Nutrition recommendations and interventions for diabetes. Diabetes Care 2007, 30:48S–65S.

    Article  Google Scholar 

  18. Wing RR, Phelan S: Long-term weight loss maintenance. Am J Clin Nutr 2005, 82(1 Suppl):222S–225S.

    PubMed  CAS  Google Scholar 

  19. North American Association for the Study of Obesity and the National Heart, Lung and Blood Institute: The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults. Bethesda, MD: National Institutes of Health; 2000. NIH Publication 00-4084.

    Google Scholar 

  20. Nonas C: Medications for the treatment of obesity. ADA Weight Management Newsletter. Winter 2007–2007; Vol 4, No.3:1–23.

    Google Scholar 

  21. Wadden T, Berkowitz R, Wonble LG, et al.: Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med 2005, 353:2111–2120.

    Article  PubMed  CAS  Google Scholar 

  22. Li Z, Maglione M, Tu W, et al.: Meta-analysis:pharmacologic treatment of obesity. Ann Intern Med 2005, 142:532–546.

    PubMed  CAS  Google Scholar 

  23. Lean ME: Sibutramine-a review of clinical efficacy. Int J Obes Relat Metab Disord 1997, 21:30S–36S.

    Google Scholar 

  24. Vettor R, Serra R, Fabris R, et al.: Effect of sibutramine on weight management and metabolic control in type 2 diabetes: a meta-analysis of clinical studies. Diabetes Care 2005, 28:942–949.

    Article  PubMed  CAS  Google Scholar 

  25. Norris S: Efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes mellitus: a meta-analysis. Arch Intern Med 2004, 164:1295–1404.

    Article  Google Scholar 

  26. Hollander PA, Elbein SC, Hirsch IB, et al.: Role of orlistat in the treatment of obese patients with type 2 diabetes: a 1-year randomized double-blind study. Diabetes Care 1998, 21:1288–1294.

    Article  PubMed  CAS  Google Scholar 

  27. Kelley DE, Bray GA, Pi-Sunyer FX, et al.: Clinical efficacy of orlistat therapy in overweight and obese patients with insulin treated type 2 diabetes: a 1-year randomized controlled trial. Diabetes Care 2002, 25:1033–1041.

    Article  PubMed  CAS  Google Scholar 

  28. Miles J, Leiter L, Hollander P, et al.: Effect of orlistat in overweight and obese patients with type 2 diabetes treated with metformin. Diabetes Care 2002, 25:1123–1128.

    Article  PubMed  CAS  Google Scholar 

  29. Halpern A, Mancini MC, Suplicy H, et al.: Latin-American trial of orlistat for weight loss and improvement in glycaemic profile in obese diabetic patients. Diabetes Obes Metab 2003, 5:180–188.

    Article  PubMed  CAS  Google Scholar 

  30. Norris SL, Zhang X, Avenell A, et al.: Efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes mellitus: a meta-analysis. Arch Intern Med 2004, 164:1395–1404.

    Article  PubMed  CAS  Google Scholar 

  31. Derosa G, Cicero AF, Murdolo G, et al.: Comparison of metabolic effects of orlistat and sibutramine treatment in type 2 diabetic obese patients. Diabetes Nutr Metab 2004, 17:222–229.

    PubMed  CAS  Google Scholar 

  32. Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L: XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 2004, 27:155–161.

    Article  PubMed  CAS  Google Scholar 

  33. Mancini MC, Halpern A: Orlistat in the prevention of diabetes in the obese patient. Vasc Health Risk Manag 2008, 4:325–336.

    PubMed  CAS  Google Scholar 

  34. Scheen AJ, Finer N, Hollander P, et al.: Efficacy and tolerability of rimonabant in overweight or obese patients with type 2 diabetes: a randomized controlled study. Lancet 2006, 368:1660–1672.

    Article  PubMed  CAS  Google Scholar 

  35. Foster-Schubert KE, Cummings DE: Emerging therapeutic strategies for obesity. Endocr Rev 2006, 27:779–793.

    PubMed  Google Scholar 

  36. Ratner RE, Dickey R, Fineman M, et al.: Amylin replacement with pramlintide as an adjunct to insulin therapy improves long-term glycaemic and weight control in type 1 diabetes mellitus: a 1-year, randomized controlled trial. Diabet Med 2004, 21:1204–1212.

    Article  PubMed  CAS  Google Scholar 

  37. Buchwald H, Avidor Y, Braunwald E, et al.: Bariatric surgery: a systematic review and meta-analysis. JAMA 2004, 292:1724–1737.

    Article  PubMed  CAS  Google Scholar 

  38. Rubino F, Gagner M: Effects of obesity surgery on non-insulin-dependent diabetes mellitus. Ann Surg 2002, 236:554–559.

    Article  PubMed  Google Scholar 

  39. Sjostrom L, Lindroos A, Peltonen M, et al.: Lifestyle, diabetes and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med 2004, 351:2683–2603.

    Article  PubMed  Google Scholar 

  40. Cunneen SA: Review of meta-analytic comparisons of bariatric surgery with a focus on laparoscopic adjustable gastric banding. Surg Obes Relat Dis 2008, 4(3 Suppl):S47–S55.

    Article  PubMed  Google Scholar 

  41. Pories WJ, Swanson MS, MacDonald KG, et al.: Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995, 222:339–352.

    Article  PubMed  CAS  Google Scholar 

  42. Tice JA, Karliner L, Walsh J, et al.: Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med 2008, 121:885–893.

    Article  PubMed  Google Scholar 

  43. Polyzogopouou EV, Kalfarentzos F, Vagenakis AG, Alexandrides TK: Restoration of euglycemia and normal acute insulin response in obese subjects with type 2 diabetes following bariatric surgery. Diabetes 2003, 52:1098–1103.

    Article  Google Scholar 

  44. Briatore L, Salani B, Andraghetti G, et al.: Restoration of acute insulin response in T2DM subjects 1 month after biliopancreatic diversion. Obesity 2007, 16:77–81.

    Article  Google Scholar 

  45. Faraj M, Havel PJ, Phelis S, et al.: Plasma acylation-stimulating protein, adiponectin, leptin, and ghrelin before and after weight loss induced by gastric bypass surgery in morbidly obese subjects. J Clin Endocrinol Metab 2003, 88:1594–1602.

    Article  PubMed  CAS  Google Scholar 

  46. Kellum JM, Kuemmerle JF, O’Dorisio TM, et al.: Gastrointestinal hormone responses to meals before and after gastric bypass and vertical banded gastroplasty. Ann Surg 1990, 211:763–770.

    Article  PubMed  CAS  Google Scholar 

  47. Hanusch-Enserer U, Brabant G: Ghrelin concentrations in morbidly obese patients after adjustable gastric banding. N Engl J Med 2003, 348:2159–2160.

    Article  PubMed  Google Scholar 

  48. le Roux CW, Aylwin SJ, Batterham RL, et al.: Gut hormone profiles following bariatric surgery favor an anorectic state, facilitate weight loss, and improve metabolic parameters. Ann Surg 2006, 243:108–114.

    Article  PubMed  Google Scholar 

  49. Laferrere B, Heshka S, Wang K, et al.: Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes. Diabetes Care 2007, 30:1709–1716.

    Article  PubMed  CAS  Google Scholar 

  50. Laferrere B, Teixeira J, McGinty J, et al.: Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes. J Clin Endocrinol Metab 2008, 93:2479–2485.

    Article  PubMed  CAS  Google Scholar 

  51. Stoeckli R, Chanda R, Langer I, Keller U:. Changes of body weight and plasma ghrelin levels after gastric banding and gastric bypass. Obesity 2004, 12:346–350.

    Article  CAS  Google Scholar 

  52. MacDonald KG, Long SD, Swanson MS, et al.: The gastric bypass operation reduces the progression and mortality of non-insulin-dependent diabetes mellitus. J Gastrointest Surg 1998, 1:213–220.

    Article  Google Scholar 

  53. Kopp HP, Kopp CW, Festa A, et al.: Impact of weight loss on inflammatory proteins and their association with the insulin resistance syndrome in morbidly obese patients. Arterioscler Thromb Vasc Biol 2003, 23:1042–1047.

    Article  PubMed  CAS  Google Scholar 

  54. Vilarrasa N, Vendrell J, Sanchez-Santos R, et al.: Effect of weight loss induced by gastric bypass on proinflammatory interleukin-18, soluble tumour necrosis factor-alpha receptors, C-reactive protein and adiponectin in morbidly obese patients. Clin Endocrinol (Oxf) 2007, 67:679–686.

    Article  CAS  Google Scholar 

  55. Holdstock C, Lind L, Engstrom BE, et al.: CRP reduction following gastric bypass surgery is most pronounced in insulin-sensitive subjects. Int J Obes (Lond) 2005, 29:1275–1280.

    Article  CAS  Google Scholar 

  56. Whitson BA, Leslie DB, Kellogg TA, et al.: Adipokine response in diabetics and nondiabetics following the Rouxen-Y gastric bypass: a preliminary study. J Surg Res 2007, 142:295–300.

    Article  PubMed  CAS  Google Scholar 

  57. Christou NV, Sampalis JS, Liberman M, et al.: Surgery decreases long-term mortality, morbidity, and health care use in morbidly obese patients. Ann Surg 2004, 240:416–423.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center for Nutrition and Weight Management, Boston Medical Center, Boston University School of Medicine, 88 East Newton Street, Robinson 4400, Boston, MA, 02118, USA

    Caroline M. Apovian

Authors
  1. Lalita Khaodhiar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sue Cummings
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Caroline M. Apovian
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Caroline M. Apovian.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Khaodhiar, L., Cummings, S. & Apovian, C.M. Treating diabetes and prediabetes by focusing on obesity management. Curr Diab Rep 9, 348–354 (2009). https://doi.org/10.1007/s11892-009-0055-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-009-0055-0

Keywords

Search

Navigation