Pharmacological Management of Obesity in Patients with Type 2 Diabetes: An Update

Abstract

Obesity is a major driver in the development of chronic metabolic disorders, such as type 2 diabetes and atherosclerosis, which also substantially increase the risk of cardiovascular disease. 1 In addition, obesity is associated with multiple comorbidities including colon, breast, kidney and digestive tract cancers as well as nonalcoholic fat-ty liver disease, osteoarthritis, sleep apnea, and depression. 2 Weight reduction is a key therapeutic goal in both the management of obesi-ty and type 2 diabetes. 3 The increase in the prevalence of type 2 diabetes is closely linked to the obesity epidemic. According to the Diabetes Fact Sheet in Ko-rea 2013, half of subjects with diabetes are obese (BMI ≥ 25 kg/m 2). 4 A recent report from the Korean Society for the Study of Obesity showed that prevalence of obesity in Korean children and adoles-cents aged 6 to 18 was about 10% in 2011. 5 The worrisome trend is that the age of onset of obesity and type 2 diabetes is progressively getting younger. Weight reduction in patients with type 2 diabetes is associated with a reduction in blood pressure, total cholesterol, and triglycer-ides, as well as a reduction in markers of inflammation and endothe-lial dysfunction. A Look Action for Health in Diabetes (AHEAD) study showed that a modest weight loss of 5-10% can improve fitness, glycemic control, and cardiovascular disease risk factors in individu-als with type 2 diabetes. 6 Although intensive lifestyle intervention (ILI) can delay progression from prediabetes to type 2 diabetes and may be beneficial in the treatment of type 2 diabetes 7,8 , the reality is that long-term weight loss through ILI is still difficult to achieve for most patients. Furthermore, the primary goal in pharmacological therapy of type 2 diabetes remains improvement of glucose control, and weight gain is commonly associated with many conventional glucose-lowering agents taken to reach the target A1C levels. 9,10 Therefore, for obese patients with type 2 diabetes who cannot lose weight with lifestyle modification, anti-obesity pharmacotherapy should be considered as an alternative option. In using anti-hyper-glycemic agents, avoidance of pharmacologically induced weight gain should also considered as a clinically important goal. 11 Given that weight management is essential for the health of over-weight and obese patients with type 2 diabetes, this review will focus on the most clinically relevant information for pharmacotherapies Type 2 diabetes is closely linked with obesity. Obesity is associated with risk of both development and progression of type 2 diabetes, as well as cardiovascular disease. Although lifestyle modifications aimed at prompting weight reduction are cornerstone therapies in managing type 2 diabetes, weight reduction remains challenging for overweight and obese patients with type 2 diabetes. A shift in the approach to weight man-agement in patients with type 2 diabetes is clearly needed. Pharmacotherapy should be considered as a realistic treatment option for patients with type 2 diabetes who cannot lose weight with health behavior modification alone. This review is focused on current pharmacotherapies for obesity to support the glycemic and weight loss goals of obese people with type 2 diabetes.