Obez Hastalarda Tip 2 Diyabet Tedavisi

ÖzObezite tip 2 diyabet etiyopatogenezinde önemli bir faktördür ve obezitenin kontrolüyle prediyabetiklerde aşıkar diyabete ilerleyişin geciktiği, diyabetik bireylerde ise glisemik kontrolün iyileştiği gösterilmiştir. Obez tip 2 diyabetik bireylerin tedavisinin yönetiminde hayat tarzı değişikliklerinin yanı sıra kullanılacak anti-diyabetik ajanlardankilo kaybı sağlayanlar ön planda seçilmelidir. Ayrıca glisemik kontrolü kötü, diyabet ilişkili komorbiditeleri olan fazla kilolu bireylerde veya obezlerde klasik tip 2 diyabet tedavilerine ek olarak anti-obezite ajanları veya uygun hasta gruplarında bariyatrik cerrahi de kullanılan diğer yöntemlerdir.
Anahtar Kelimeler:

Obezite, tip 2 diyabet, tedavi

Type 2 Diabetes Treatment in Obese Patients

AbstractObesity is an important factor palying a role in the etiopathogenesis of type 2 diabetes mellitus and it was shown that obesity management can delay the progression of pre-diabetes to overt diabetes and improve the glycemic control of diabetic patients. Along milk life style modification, anti-diabetic drugs that lead to weight loss should be pre-ferred primarily in the management of obese type 2 diabetic patients. Moreover, anti-obesity medications and for selected patients, bariatric surgery may be used in combination with anti-diabetic drugs in overweight or obese patients who have poor glycemic control and comorbidities related to diabetes.

___

  • Kaynaklar 1.IDF Diabetes Atlas. 7th ed2015. 2.Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al.Twelve-year trends in the prevalence and risk factors of diabetes andprediabetes in Turkish adults. European journal of epidemiology.2013;28(2):169-80. 3.Malin SK, Kashyap SR. Type 2 Diabetes Treatment in the Patient withObesity. Endocrinology and metabolism clinics of North America.2016;45(3):553-64. 4.Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, LachinJM, Walker EA, et al. Reduction in the incidence of type 2 diabeteswith lifestyle intervention or metformin. The New England journalof medicine. 2002;346(6):393-403. 5.UK Prospective Diabetes Study 7: response of fasting plasma glu-cose to diet therapy in newly presenting type II diabetic patients,UKPDS Group. Metabolism: clinical and experimental.1990;39(9):905-12. 6.Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Tay-lor R. Reversal of type 2 diabetes: normalisation of beta cell func-tion in association with decreased pancreas and liver triacylglyce-rol. Diabetologia. 2011;54(10):2506-14.7.American Diabetes A. 7. Obesity Management for the Treatment ofType 2 Diabetes. Diabetes care. 2017;40(Suppl 1):S57-S63. 8.Goldstein DJ. Beneficial health effects of modest weight loss. Inter-national journal of obesity and related metabolic disorders : jour-nal of the International Association for the Study of Obesity.1992;16(6):397-415. 9.Pastors JG, Warshaw H, Daly A, Franz M, Kulkarni K. The eviden-ce for the effectiveness of medical nutrition therapy in diabetes ma-nagement. Diabetes care. 2002;25(3):608-13. 10.Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H,Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by chan-ges in lifestyle among subjects with impaired glucose tolerance. TheNew England journal of medicine. 2001;344(18):1343-50. 11.Houmard JA, Tanner CJ, Slentz CA, Duscha BD, McCartney JS, Kra-us WE. Effect of the volume and intensity of exercise training on in-sulin sensitivity. Journal of applied physiology. 2004;96(1):101-6. 12.Look ARG. Eight-year weight losses with an intensive lifestyle inter-vention: the look AHEAD study. Obesity. 2014;22(1):5-13. 13.Look ARG, Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, et al.Cardiovascular effects of intensive lifestyle intervention in type 2 dia-betes. The New England journal of medicine. 2013;369(2):145-54. 14.Wing RR, Goldstein MG, Acton KJ, Birch LL, Jakicic JM, Sallis JF,Jr., et al. Behavioral science research in diabetes: lifestyle changesrelated to obesity, eating behavior, and physical activity. Diabetescare. 2001;24(1):117-23. 15.Venditti EM, Bray GA, Carrion-Petersen ML, Delahanty LM,Edelstein SL, Hamman RF, et al. First versus repeat treatment witha lifestyle intervention program: attendance and weight loss outco-mes. International journal of obesity. 2008;32(10):1537-44. 16.Diabetes Prevention Program Research G. Long-term effects of li-festyle intervention or metformin on diabetes development and mic-rovascular complications over 15-year follow-up: the Diabetes Pre-vention Program Outcomes Study. The lancet Diabetes & endocri-nology. 2015;3(11):866-75. 17.Davies MJ, Bergenstal R, Bode B, Kushner RF, Lewin A, Skjoth TV,et al. Efficacy of Liraglutide for Weight Loss Among Patients WithType 2 Diabetes: The SCALE Diabetes Randomized Clinical Trial.Jama. 2015;314(7):687-99. 18.Wadden TA, Hollander P, Klein S, Niswender K, Woo V, Hale PM,et al. Weight maintenance and additional weight loss with liraglu-tide after low-calorie-diet-induced weight loss: the SCALE Mainte-nance randomized study. International journal of obesity.2013;37(11):1443-51. 19.Liu SC, Tu YK, Chien MN, Chien KL. Effect of antidiabetic agentsadded to metformin on glycaemic control, hypoglycaemia and we-ight change in patients with type 2 diabetes: a network meta-analy-sis. Diabetes, obesity & metabolism. 2012;14(9):810-20. 20.Monami M, Nardini C, Mannucci E. Efficacy and safety of sodiumglucose co-transport-2 inhibitors in type 2 diabetes: a meta-analy-sis of randomized clinical trials. Diabetes, obesity & metabolism.2014;16(5):457-66. 21.Bailey CJ, Gross JL, Pieters A, Bastien A, List JF. Effect of dapag-liflozin in patients with type 2 diabetes who have inadequateglycaemic control with metformin: a randomised, double-blind, pla-cebo-controlled trial. Lancet. 2010;375(9733):2223-33. 22.DeFronzo RA, Tripathy D, Schwenke DC, Banerji M, Bray GA, Buc-hanan TA, et al. Pioglitazone for diabetes prevention in impaired glu-cose tolerance. The New England journal of medicine.2011;364(12):1104-15. 23.TEMD Obezite LM, Hipertansiyon Çalışma Grubu. Obezite Tanı veTedavi Kılavuzu. Ankara2016. 24.Garvey WT, Ryan DH, Look M, Gadde KM, Allison DB, Peterson CA,et al. Two-year sustained weight loss and metabolic benefits with con-trolled-release phentermine/topiramate in obese and overweight adults(SEQUEL): a randomized, placebo-controlled, phase 3 extensionstudy. The American journal of clinical nutrition. 2012;95(2):297-308. 25.Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L. XENical in theprevention of diabetes in obese subjects (XENDOS) study: a rando-mized study of orlistat as an adjunct to lifestyle changes for the pre-vention of type 2 diabetes in obese patients. Diabetes care.2004;27(1):155-61. 26.O'Neil PM, Smith SR, Weissman NJ, Fidler MC, Sanchez M, ZhangJ, et al. Randomized placebo-controlled clinical trial of lorcaserinfor weight loss in type 2 diabetes mellitus: the BLOOM-DM study.Obesity. 2012;20(7):1426-36. 27.Hollander P, Gupta AK, Plodkowski R, Greenway F, Bays H, BurnsC, et al. Effects of naltrexone sustained-release/bupropion sustained-release combination therapy on body weight and glycemic parame-ters in overweight and obese patients with type 2 diabetes. Diabe-tes care. 2013;36(12):4022-9. 28.Brethauer SA, Aminian A, Romero-Talamas H, Batayyah E, Mackey J,Kennedy L, et al. Can diabetes be surgically cured? Long-term meta-bolic effects of bariatric surgery in obese patients with type 2 diabetesmellitus. Annals of surgery. 2013;258(4):628-36; discussion 36-7. 29.Ribaric G, Buchwald JN, McGlennon TW. Diabetes and weight incomparative studies of bariatric surgery vs conventional medical the-rapy: a systematic review and meta-analysis. Obesity surgery.2014;24(3):437-55. 30.Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, Nava-neethan SD, et al. Bariatric surgery versus intensive medical therapyfor diabetes--3-year outcomes. The New England journal of medi-cine. 2014;370(21):2002-13.