New Diabetes Treatment Standards Put Obesity Up Front

New diabetes treatment guidelines published by the American Association of Clinical Endocrinologists (AACE) provide a central role for obesity treatment. These guidelines are the result of a trend that has taken shape over the last five years as the role of obesity in the growing prevalence of diabetes has become impossible to ignore.

Five years ago, diabetes treatments that cause weight gain, Avandia and Actos, were commonly prescribed. As safety problems have pushed these drugs out of use, Metformin and newer drugs with less liability for causing weight gain are increasingly favored. In its 2013 Standards for Care, the American Diabetes Association (ADA) calls for a patient-centered approach that considers the effect on weight when prescribing treatment for type 2 diabetes.

But even more significant is the increasing emphasis on treating obesity to prevent or reverse the progression of diabetes. Alan Garber, AACE President and the guidelines task force chair, says obesity is now an integral part of diabetes treatment. New obesity treatments, like lorcaserin and phentermine/topiramate, make this possible.

“The data with those agents are relatively persuasive that they lower blood sugar almost as much as oral agents,” Garber told MedPage Today. “If you have substantially obese patients with mild diabetes, physicians should consider weight management as a strategy by which to reduce blood sugar.”

Likewise the new ADA standards call for a more patient-centered approach to type-2 diabetes treatment, rather than a singular focus on blood glucose. Treating obesity, hyperlipidemia, and hypertension in both patients with diabetes and pre-diabetes has gained increased importance in these new standards. The standards even go so far as recommending consideration of bariatric surgery for appropriate patients, noting:

Bariatric surgery has been shown to lead to near- or complete normalization of glycemia in ∼40–95% of patients with type 2 diabetes, depending on the study and the surgical procedure.

All this represents one more step in the process of dealing with obesity objectively as a health condition, leaving behind failed strategies grounded in shame and blame.

Click here to read more about the AACE guidelines, here to read more about the ADA position on patient centered care, and here to read the 2013 ADA Standards of Medical Care in Diabetes.

Embryonic Mouse Pancreas (red), image © Vincent Pasque, University of Cambridge, Wellcome Images 

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