What is the role of obesity management and weight loss in the AACE comprehensive type 2 diabetes treatment algorithm?

Updated: Sep 27, 2021
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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In 2013, the American Association of Clinical Endocrinologists (AACE) issued a comprehensive new type 2 diabetes treatment algorithm--the first to incorporate obesity, prediabetes, and cardiovascular risk factor management. [284, 285]

Obesity management was incorporated into the algorithm because it is now clear that weight loss also reduces blood glucose. The authors suggest that obesity management can be considered first-line treatment for people with prediabetes. The prediabetes section of the algorithm considers cardiovascular risk factors and the options of antihyperglycemic or antiobesity therapy, though without making a recommendation regarding which form of treatment is better.

As in the AACE's earlier glycemic-control algorithm, the level of treatment depends on the initial hemoglobin A1c (HbA1c). (Lifestyle modification, including weight loss, is a component of all treatments.) Whereas the earlier algorithm recommended an HbA1c of 6.5% or lower as the goal for most patients, the current algorithm refines this advice, recommending an HbA1c of 6.5% or lower for healthy patients without concurrent illness and at low risk for hypoglycemia but individualized target HbA1c values greater than 6.5% for patients with concurrent illness and those who are at risk for hypoglycemia.

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