Via practica 4/2016

Diabezita, narastajúci medicínsky problém – diabetológ musí byť aj obezitológ

doc. MUDr. Boris Krahulec, CSc., MUDr. Daša Mesárošová, PhD.

Obezita a diabetes mellitus (DM) 2. typu sú veľmi úzko na seba naviazané. Na celom svete stúpa počet obéznych aj počet diabetikov, a teda aj diabezity. Diabetológ musí byť preto aj obezitológ. V manažmente obéznych pacientov s diabetes mellitus 2. typu sa opiera o režimové opatrenia (nízkokalorickú diétu a telesné cvičenie), kognitívno-behaviorálnu terapiu, medikamentóznu liečbu obezity a najmä výber antidiabetík, ktoré znižujú telesnú hmotnosť (metformín, antagonisty GLP-1 a gliflozíny) alebo sú aspoň hmotnostne negatívne (DPP-IV inhibítory). Z inzulínov sa uprednostňujú analógy, ktoré majú najnižší prírastok na hmotnosti. Za pomoci bariatrickej metabolickej chirurgie je možná aj remisia DM 2. typu. Diabetológ by mal viac spolupracovať s dietológom, psychológom či bariatrickým chirurgom.

Kľúčové slová: obézny diabetik 2. typu, diabezita, manažment obézneho diabetika 2. typu

Diabesity, an increasing medical problem – diabetologist must be therefore also an obesitologist

Obesity and type 2 diabetes mellitus have very close relationship. In the whole world the number of obese people and diabetics and therefore also diabesity is increasing. Diabetologist must be therefore also an obesitologist. The cornerstone in the management of an obese type 2 diabetic patient is therapeutic lifestyle intervention, which includes restricting calories and simultaneously increasing physical activity, cognitive behavioral therapy has been introduces into psychological therapy. Pharmacological therapy is oriented to hypoglycemic drugs, such as metformin, GLP-1 agonists and gliflozins, which are connected with weight loss, or DPP-IV inhibitors, which are weight neutral. Priority of insulin therapy are insulin analogs, which are connected with less weight gain. Bariatric surgery seems to induce remission of type 2 diabetes. Diabetologist must more cooperate with dietitian, psychologist and bariatric surgeon.

Keywords: obese type 2 diabetic, diabesity, management of obese type 2 diabetic patient