Treatment of obese diabetics

Abstract

Fat accumulation is a typical phenomenon in the pathogenesis of Type 2 diabetes. Also Type 1 diabetics are getting obese these days living in an environment with typical caloric overfeeding and low physical activity. Weight reduction is an important part of therapy in all obese diabetic patients. Orlistat is the only accessible antiobesity drug today. Weight neutral antidiabetics like metform in and DPP-4 inhibitors can be also used. Incretin analogues (exenatide and liraglutide) are also very important drugs inducing weight loss in diabetic and also in nondiabetic patients. Insulin therapy causes mostly weight gain. Long acting insulin analogues are able to induce small weight loss in Type 1 diabetes or only a small weight increase or weight loss in Type 2 diabetic pat ients. Procedures of bariatric surgery are very important in the treatment being able to induce remission of Type 2 diabetes. Weight reduction can be supported also using the new class of antiadiabetic drugs-SGLT inhibitors which are blocking glucose absorption in kidneys. The use of new incretine analogues injected at the interval of one to two weeks is the most important strategy for the treatment of obese Type 2 diabetic patients and perhaps also of Type 1 diabetic patients even in combination with insulin.