8. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes:Standards of Medical Care in Diabetes—2022

Abstract

The American Diabetes Association (ADA) “Standards of Medical Care in Diabetes” includes the ADA’s current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc22-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA’s clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc22-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.

Neurohormonal Changes in the Gut–Brain Axis and Underlying Neuroendocrine Mechanisms following Bariatric Surgery

“…Long-term observational studies have reported not only sustainable weight loss but also improvements in the metabolic profile after BS, especially in terms of glycemic and lipid metabolism [ 12 ]. There is strong evidence suggesting that compared to lifestyle intervention and pharmacotherapy, BS may result in superior glycemic control, often leading to the remission of diabetes, while reducing cardiovascular risk factors in patients with type 2 diabetes mellitus (T2DM) [ 13 , 14 ]. Studies including the SOS, STAMPEDE and CROSSROAD trials have demonstrated the effectiveness of BS in T2DM remission and prevention [ 15 , 16 , 17 ].…”

“…Moreover, bariatric surgery should also be considered as a treatment option for adults with T2DM and a BMI of 30.0–34.9 who have inadequate glycemic control and cannot achieve sustainable weight loss despite lifestyle changes and optimal treatment. [ 13 , 14 , 18 ]. Additionally, BS is associated with both short- and long-term improvement in dyslipidemia, as shown by the STAMPEDE trial, which reported reductions in triglyceride levels of 40% and 29% in the RYGB and VSG groups, respectively.…”

Lifestyle changes in patients with non-alcoholic fatty liver disease: A systematic review and meta-analysis

“…This reduction can be compensated by adding exercise as it increases metabolic rate and energy expenditure [ 76 ]. Together diet and exercise can enhance weight loss and maintain it in the long-term [ 76 ]; this is the most recommended strategy to achieve weight loss in different metabolic diseases guidelines [ 11 , 77 ]. Contrary to this, there are some studies sustaining that exercise may not enhance weight loss but gives other important benefits.…”

Cardiovascular effects of intensive lifestyle intervention in adults with overweight/obesity and type 2 diabetes according to body weight time in range

“…The marked growth of the dual epidemics of type 2 diabetes and obesity contributes directly to the increasing prevalence of cardiovascular disease (CVD) and represents one of the most important public health challenges worldwide. 1 , 2 , 3 , 4 Weight loss with intensive lifestyle intervention (ILI) has become a standard recommendation in the guidelines for the management of individuals with type 2 diabetes and comorbid obesity 5 ; however, the level of evidence for such recommendations is only in “class B” because the evidence provided by randomized studies is limited. 5 The Look AHEAD (Action for Health in Diabetes) trial, 6 the largest trial to date of an ILI for adults with overweight/obesity and type 2 diabetes, did not show a significant reduction in cardiovascular morbidity or mortality.…”

“… 1 , 2 , 3 , 4 Weight loss with intensive lifestyle intervention (ILI) has become a standard recommendation in the guidelines for the management of individuals with type 2 diabetes and comorbid obesity 5 ; however, the level of evidence for such recommendations is only in “class B” because the evidence provided by randomized studies is limited. 5 The Look AHEAD (Action for Health in Diabetes) trial, 6 the largest trial to date of an ILI for adults with overweight/obesity and type 2 diabetes, did not show a significant reduction in cardiovascular morbidity or mortality. Of note, although the majority of the participants in the intervention group (55·1%) had achieved the study weight loss goal (Loss of ≥7% of baseline weight) at year 1, 7 they had not maintained this weight loss at the end of the trial due to weight regain.…”