AGGRESSIVE WEIGHT-REDUCTION TREATMENT IN THE MANAGEMENT OF TYPE-2 DIABETES

Most patients with Type 2 diabetes are significantly overweight and di et-induced weight loss can provide marked improvement in their glycaem ic control. As conventional therapy combining diet and exercise usuall y has a poor long-term success rate, more aggressive weight reduction programmes have been proposed for the treatment of severely obese diab etic patients, including very-low-calorie diets, antiobesity drugs and bariatric surgery. Very-low-calorie diets usually have a remarkable s hort-term effect and energy restriction and weight reduction are posit ive factors for the glycaemic control of obese diabetic subjects. Howe ver,the long-term efficacy of these methods remains doubtful since wei ght regain is a common phenomenon. Although anti-obesity (anorectic) d rugs may help patients to follow a restricted diet and lose weight, th eir overall efficacy on body weight and glycaemia is generally modest, and their long-term safety still questionable. Interestingly, seroton inergic anorectic agents have been shown to improve both the insulin s ensitivity and glycaemic control of obese diabetic patients independen tly of weight loss. Bariatric surgery may be helpful in well-selected patients. The correction of weight excess after successful gastroplast y fully reverses the abnormalities of insulin secretion, clearance and action on glucose metabolism present in markedly obese non-diabetic p atients, and allows interruption or reduction of insulin therapy and a ntidiabetic oral agents in most obese diabetic patients. In conclusion , weight loss is a major goal in treating obese patients with Type 2 d iabetes, and aggressive weight reduction programmes may be used in sel ected patients refractory to conventional diet and drug treatment. How ever, long-term prospective studies are needed for more precise determ ination of the role of such a strategy in the overall management of ob ese diabetic patients.