The challenge of managing coexistent type 2 diabetes and obesity

From trainee to consultant, BMJ Group offers doctors around the world tailored information, special events, learning resources and recruitment services at every step along their career path.

... by doctors, for doctors, for patients
We are open for entries!

Online learning

BMJ Learning

High-quality CME / CPD for doctors and other healthcare professionals. BMJ Learning features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. Find out more

Courses and Qualifications

BMJ Masterclasses

BMJ Masterclasses, led by experts, help clinicians to use the latest evidence and recent guidelines in practice and meet their CPD/CME requirements. Find out more

Exam Preparation

The leading provider of online exam preparation, helping over 167,000 healthcare professionals to pass their exams. Find out more

onExamination

Search all BMJ education articles:

From

Limit by

The BMJ iPad app brings you the best of print and online, including live links to the latest news, blogs, video, and podcasts. Get the BMJ iPad app.
You can use bmj.com to help you with your continuing medical education. Find out about CME/CPD credits for BMJ articles
Keep up to date with cardiology: Access the latest cardiovascular medicine resources from across BMJ Group.
Countdown to London 2012: BMJ Group's Olympics portal highlights latest Olympics and sports medicine-themed research, comment and learning

Access to the full text of this article requires a subscription or payment. Please log in or subscribe below.

Clifford J Bailey, professor

¹Life and Health Sciences, Aston University, Birmingham B4 7ET, UK

Correspondence to: C J Bailey c.j.bailey{at}aston.ac.uk

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 …