Perspectives on Diabetes Care

Connections between Weight Loss and Diabetes

Oct 15, 2013, 00:00 AM

I was recently reading an intriguing review of weight loss and diabetes written by Kathleen Wyne, MD, PhD.  I enjoy reading articles by Dr. Wyne, as I serve with her on a subcommittee of the Texas Diabetes Council where Dr. Wyne always brings thoughtful, organized comments to the topics being discussed.

I am going to try to summarize her article for those of you who have not had a chance to read it.

• Prior to 1995 and the introduction of metformin to the United States market, it was believed that improving blood glucose control had to be accompanied by at least a 20 pound weight gain.
• Patients and healthcare professionals had to relearn the fact that weight gain did not have to accompany diabetes control.  In fact, we have learned how important weight control is in diabetes management.
• Coincidentally, in 1995 there was also an article published in Annals of Surgery which established gastric bypass surgery as a safe and effective means of improving the control of Type 2 diabetes mellitus (T2DM).
• Controversy still exists over whether the focus should be on weight loss to decrease insulin resistance, pharmacologic therapy to improve beta cell function or a combination of the two therapies.
• When the 14-year study results were reported in 1995, it was found that the control of weight and T2DM resulting from gastric bypass also corrected or alleviated other co-morbid conditions associated with obesity such as hypertension, sleep apnea, cardiopulmonary failure, arthritis, and infertility.
• The practical challenges involved in weight management include determining how much weight loss is required to improve or control the T2DM.  Additional considerations are strategies to lose weight, how to maintain the weight loss and who will pay for it.
• The current controversy is whether or not bariatric surgery cures T2DM.  Bariatric surgery consistently shows improvement in blood glucose control, often allowing patients to decrease their medications and even to stop diabetes drugs completely.
• To be considered a “cure” for T2DM, it would require that the beta cell function be restored with normal first-phase and second-phase insulin release.  This has not been demonstrated after bariatric surgery.  Achieving a “normal” A1c does not constitute a “cure” but perhaps should be considered as T2DM in “remission.”
• Dr. Wyne acknowledges that pharmacologic agents can help with weight loss although specific drugs are not addressed.   Medically supervised very-low-calorie liquid diets are also an option.   There are also devises being investigated such as an endoscopically placed duodenal-jejunal bypass liner.
• Dr. Wyne stresses the importance of not just looking at weight loss, but the significance of the mode to sustain weight loss long term.

For more information and details, see the Sept/Oct 2013 issue of Practical Diabetology.