Managing Weight Loss in Patients with Diabetes Mellitus

Sunday, October 12, 2014 at 2:40 pm

LAS VEGAS—For patients with type 2 diabetes mellitus (T2DM), weight management is paramount for the optimal management of symptoms.

“Healthcare providers [should] recognize that imperative medication management in patients with T2DM begins with a weight loss effort,” said Donna H. Ryan, MD, professor emeritus at Pennington Biomedical Research Center in Baton Rouge, LA.

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In her presentation, “Effective Weight Loss in Diabetic Patients,” Ryan outlined the American Diabetes Association recommendations including a blood pressure of 140/80 mm Hg, an LDL-cholesterol level of <100 mg/dL, triglycerides at <150 mg/dL, HDL-cholesterol at <40 mg/dL for men and <50 mg/dL for women, HbA1c levels <7%, and blood sugar levels between 100 mg/dL and 120 mg/dL before meals. The question is whether treatment will address these risk factors.

In patients with diabetes mellitus, challenges include:

• Medications. Diabetic drugs (eg, insulin, sulfonylureas, thiazolidinediones), as well as antidepressants and antipsychotics, can promote weight gain.
• Exercise. Diabetes is a cardiovascular disease risk equivalent. In addition, calorie restrictions with increased exercise can promote hypoglycemia.

Ryan said combatting hypoglycemia should be done by reducing medications for T2DM rather than adding food to raise blood sugar levels.

The rule of thumb, she said, is that calorie restriction, independent of weight loss, improves glycemic control. Weight loss improves glycemic control further.

When it comes to adjusting diabetes medication during weight loss, there are several factors to consider. First, the duration of diabetes may affect the outcome. Initial glycemic control will affect the level of blood glucose change. While some weight loss is good, more weight loss is better. Approximately 50% of changes in fasting blood glucose levels will occur within the first 10 days with calorie restrictions.

As healthcare practitioners, advise your patients with T2DM to prepare for weight loss by first identifying high-risk patients and begin monitoring. Then adjust medications accordingly—eg, reduce antidiabetic medication at the start of weight loss based on a pre-diet blood glucose monitoring. Finally, monitor glucose logs and episodes of hypoglycemia until the patient is stable.

“Ultimately, weight loss can improve A1c test results, plasma glucose, blood pressure, triglycerides, HDL cholesterol levels, and reduce the need for medications in patients with diabetes,” Ryan said.

-Michelle Canales