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Medical Management of Diabesity: Do We Have Realistic Targets?

  • Pharmacologic Treatment of Type 2 Diabetes (HE Lebovitz and G Bahtiyar, Section Editors)
  • Published:
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Abstract

Purpose of Review

The global prevalence of “diabesity”—diabetes related to obesity—is increasing steadily over the past few decades because of the obesity epidemic. Although bariatric surgery is an effective treatment option for patients with diabesity, its limited availability, invasiveness, relatively high costs and the potential for surgical and postsurgical complications restrict its widespread use. Therefore, medical management is the only option for a majority of patients with diabesity. Diabetes control with several anti-diabetic agents, including insulin, causes weight gain with probability of worsening diabesity. Rational use of anti-diabetic medications with weight loss potential in varying combinations may help to address this key issue for long-term management of diabesity. There is no consensus on such an approach from different professional bodies like American Diabetes Association, European Association for Study of Diabetes, or International Diabetes Federation. We attempt to discuss the key issues and realistic targets for diabesity management in this paper.

Recent Findings

Rational use of anti-diabetic combinations can mitigate worsening of diabesity to some extent while managing patients.

Summary

Retrospective studies showed that combination therapy with glucagon-like peptide-1 (GLP-1) receptor agonists and sodium glucose co-transporter 2 (SGLT-2) inhibitors, when administered along with other anti-diabetic medications, offer the best therapeutic benefit in the medical management of diabesity. Different combinations of other anti-diabetic drugs with minimum weight gain potential were also found useful. Because of insufficient evidence based on prospective randomised controlled trials (RCTs), future research should focus on evolving the appropriate rational drug combinations for the medical management of diabesity.

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Authors and Affiliations

  1. Department of Endocrinology and Diabetes, Royal Lancaster Infirmary, University Hospitals of Morecambe NHS Trust, Ashton Road, Lancaster, LA1 4RP, UK

    Joseph M. Pappachan

  2. Department of Endocrinology and Diabetes, New Cross Hospital, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK

    Ananth K. Viswanath

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Correspondence to Joseph M. Pappachan.

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Joseph M. Pappachan declares that he has no conflict of interest. Ananth K. Viswanath received lecture fees from MSD, NovoNordisk, Takeda, Eli Lilly and Jansen and sponsorship from NovoNordisk, Takeda, Novartis and Jansen to attend international conferences.

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This article is part of the Topical Collection on Pharmacologic Treatment of Type 2 Diabetes

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Pappachan, J.M., Viswanath, A.K. Medical Management of Diabesity: Do We Have Realistic Targets?. Curr Diab Rep 17, 4 (2017). https://doi.org/10.1007/s11892-017-0828-9

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