Endocrinology and Metabolism Clinics of North America
Review articleObesity and type 2 diabetes
Section snippets
Association between obesity and type 2 diabetes
Obesity has long been recognized as a significant risk factor for the development of type 2 diabetes. Early studies showed that the degree of obesity in a population had the largest environmental influence on the prevalence of diabetes [7]. In the Nurses' Health Study, which has observed more than 84,000 female nurses for 16 years, overweight or obesity was the single most important predictor of type 2 diabetes [8]. In that study, the risk of developing diabetes increased 20.1-fold at a body
Impact of obesity on type 2 diabetes
Obesity increases insulin resistance and glucose intolerance [21] and exacerbates metabolic abnormalities present in type 2 diabetes, such as hyperinsulinemia, hyperglycemia, and dyslipidemia [2]. Obesity thus complicates the management of type 2 diabetes and makes it more difficult to treat pharmacologically [22]. An additional complication is that several of the agents used to treat type 2 diabetes, such as insulin, sulfonylureas, and thiazolidenediones, promote weight gain [22].
Obesity
Benefits of weight loss in type 2 diabetes
Weight loss has beneficial effects on virtually every aspect of type 2 diabetes (Box 1). Within the first week of intensive dieting, fasting hyperglycemia rapidly declines [27], [28]. This early reduction in fasting glucose is paralleled by reductions in hepatic glucose production and urinary glucose excretion [27]. Much of the early improvement in glycemia occurs before significant weight loss and thus results largely from caloric restriction [27]. With the progression and maintenance of
Treatment of obesity in type 2 diabetes
As in the general population, weight loss interventions for the treatment of obesity in patients who have type 2 diabetes have included diet, exercise, and behavioral therapy. Weight loss pharmacotherapy and bariatric surgery also have been used.
Prevention of type 2 diabetes
As previously described, currently available weight loss interventions induce some degree of short-term weight loss and improvement of glycemic control in obese patients who have type 2 diabetes. With the exception of bariatric surgery, whose use is restricted to severely obese individuals, weight loss interventions are seldom effective in maintaining significant weight loss and improved glycemic control. Interventions that prevent or delay the progression to type 2 diabetes in at-risk
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