Weight Gain & Type 2 Diabetes
Diabetes & Obesity
Type 2 diabetes is strongly associated with obesity. This is true of populations
such as the Pima Indians and some Polynesian groups moving from subsistence
to plenty, but it is also true of western society generally. Obesity is
not, however, sufficient by itself to cause type 2 diabetes. The sub set
of the population that succumb clearly have genetic traits as well as
the environmental trigger. There is little that we can do about the population
gene traits and much that we could potentially do about food consumption
and exercise. The problem is turning that potential into practice.
Weight Gain & Insulin
The situation at the onset of type 2 diabetes then is that much of the
battle for optimizing habits such as regular exercise and healthy eating
has already been lost. In clinical practice we have failed spectacularly
to change behavior after diagnosis towards exercise regimens and eating
habits that have the potential to reverse the pathology. Middle aged overweight
people do not, and maybe cannot, take up enough exercise to influence
the process and eating habits are socially and habitually ingrained. Therapies
which increase insulin secretion are generally associated with progressive
weight gain, though we do not have enough data before diagnosis to be
certain as to whether this is a continuing trend in body mass. Certainly
the UKPDS showed a weight gain of a median 4 kg in such people.
Weight Gain & Metformin
Weight increase was much improved in those treated less intensively for
their glycemia and interestingly in those given metformin. Those overweight
subjects who were on metformin had improved glycemia without a large weight
increase and it may be this specific combination that caused the best
benefit for tissue damage outcome in type 2 diabetes. However, the UKPDS
was clear in its conclusion that of the two evils hypoglycemia was worse
than weight increase. With the advent of thiazolidinediones, where weight
increases even faster than with insulin or sulphonylurea, we will need
to wait for the outcome of clinical trials before deciding whether these
agents are suitable for widespread use or whether we should reserve them
for specific indications. New agents such as GLP1 analogues now in commercial
pipelines may have the potential to control glycemia without weight increase.
Certainly this seems to be a finding in primate studies.
Prevention of Weight Gain by Clinical
Practice
We know that in specific cases it is possible to stop weight increase
or even reverse it but the tragedy is that in general clinical practice
we are not achieving such an outcome, and it is likely that the morbidity
of diabetes is significantly compounded and exacerbated by obesity.
Source: Dr David Matthews, Diabetes Research Laboratory, Radcliffe Infirmary,
Oxford, UK. (2002)
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