Via practica 12/2005

THERAPY OF OBESE PATIENTS WITH DIABETES MELLITUS

Type 2 diabetes mellitus is strongly associated with obesity. Lifestyle modification is the cornerstone of both the prevention of type 2 diabetes in at risk overweight individuals and the treatment of obese patients with type 2 diabetes. Initial recommendations to any obese diabetic patient should include optimisation of the meal plan and enhancement of physical activity. Psychological approach may be helpful with cognitive-behavioral therapy. If we are unsuccessful, pharmacology therapy may be considered (sibutramin, orlistat, in the near future also rimonabant). If morbid obesity is present, there is possible role of bariatric surgery. For improving blood glucose control, agents decreasing insulin resistance (metformin or thiazolidindiones) are the first choice antidiabetic agents in obese patients with type 2 diabetes. Most obese diabetic patients have metabolic syndrome, therefore risk factors, such as arterial hypertension and dyslipidaemias must be also treated, the best choice of treatment are ACE inhibitors, angiotensin AT1-reeceptor antagonists, statins and fibrates. Therapy of obese diabetic patient must be multifactorial and multidisciplinary.

Keywords: obesity, diabetes mellitus, metabolic syndrome.