Clinical Review

The challenge of managing coexistent type 2 diabetes and obesity

BMJ 2011; 342 doi: (Published 13 April 2011) Cite this as: BMJ 2011;342:d1996
  1. Clifford J Bailey, professor
  1. 1Life and Health Sciences, Aston University, Birmingham B4 7ET, UK
  1. Correspondence to: C J Bailey c.j.bailey{at}
  • Accepted 11 March 2011

Summary points

  • The presence of obesity with type 2 diabetes increases morbidity and mortality from each condition

  • Excess adiposity accentuates insulin resistance and complicates the treatment of type 2 diabetes

  • Glucagon-like peptide 1 receptor agonists promote weight loss, whereas metformin, dipeptidyl peptidase 4 inhibitors, and α glucosidase inhibitors are typically weight neutral

  • The anabolic effects of increased insulin secretion and action restrict the benefits of treatment in obese patients

  • New treatments should ideally reduce hyperglycaemia and excess adiposity

  • Potential new treatments include analogues of intestinal and adipocyte hormones, inhibitors of renal glucose reabsorption and cellular glucocorticoid activation, and activators of cellular energy production

Coexistent type 2 diabetes and obesity—often termed “diabesity”—is an emerging epidemic that poses a challenge to the treatment of both conditions.1 More than 90% of the world’s 285 million people with diabetes have type 2 diabetes, and this number is projected to grow to 438 million by 2030.2 In North America about 90% of people with type 2 diabetes are obese (body mass index >30 (weight (kg)/height (m)2)), overweight (body mass index 25-29.9), or have a medical history of being so, and those who are not overweight may carry an excess of hidden visceral fat.3 A large cohort study estimated that a body mass index of 30-34.9 (compared with 22) for 16 years increased the risk of type 2 diabetes more than 20-fold in women, and a large cross sectional study of North American men aged 25-54 estimated that a body mass index of 30-34.9 increased the risk more than 10-fold.w1 w2

Sources and selection criteria

This article is largely based on a search, focused on the treatment of hyperglycaemia, of original articles published between 2005 and 2010 using Medline, PubMed, Cochrane Library, and Google Scholar. The main search terms were hyperglycaemia, diabetes, diabesity, and obesity together with …

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