Diabetes and obesity: Managing dual epidemics

The odds are high that practitioners who manage patients with diabetes are also managing patients who are overweight or obese. The numbers are staggering: more than two-thirds of American adults with type 2 diabetes are obese, and the need to address these dual epidemics is clear. Many strategies exist, but how does a practitioner select the best option for an individual patient? This Cleveland Clinic Journal of Medicine supplement on diabetes and obesity includes articles by experts who review the evidence on the impact of different diets and exercise and the use of “weight-friendly” diabetes medications, drug therapy, and metabolic surgery in managing obesity in patients with diabetes.

For some patients with type 2 diabetes, changes in diet and exercise are beneficial in managing the disease and can lead to weight loss. Diets abound, but what diets are best, particularly for patients with obesity? Zahrae Sandouk, MD, and I review several popular diets and what is known about their effects on weight loss, glycemic control, and cardiovascular risk.

As for exercise, both aerobic and resistance training are essential to improve glucose regulation and cardiovascular health. John P. Kirwan, PhD, Jessica Sacks, and Stephan Nieuwoudt review exercise recommendations, modalities, and the metabolic benefits of exercise for this patient population.

Drug therapy typically focuses on the diabetes side of the coin and not necessarily the obesity side; however, practitioners are increasingly helping patients establish goals on both fronts. To that end, Mary Angelynne Esquivel, MD, and I discuss medications for treatment of type 2 diabetes that also have weight loss as a side effect, including glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, neuroendocrine peptide hormones, alpha-glucosidase inhibitors, and metformin.

The heightened focus on addressing obesity warrants consideration of medications for weight loss. Bartolome Burguera, MD, PhD, Khawla F. Ali, MD, and Juan P. Brito, MD, discuss a potential shift in thinking: using antiobesity drugs to manage type 2 diabetes. The authors review pharmacologic therapies approved for managing obesity in the context of diabetes.

While initially used for patients with severe obesity, bariatric surgery is now called metabolic surgery when used for type 2 diabetes because of its dramatic impact in reversing type 2 diabetes. Philip R. Schauer, MD, Zubaidah Nor Hanipah, MD, and Francesco Rubino, MD, describe the benefits of metabolic surgery and review the evidence that led diabetes organizations to set new guidelines with a lower body mass index threshold than previously recommended.

The dual epidemics of diabetes and obesity present physicians with a complex set of considerations to help patients achieve their treatment goals on both fronts in the battle. I hope you find this supplement on diabetes and obesity informative and useful to you to enhance patient care.

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