Treating the Obese Diabetic

Julia Kenkre; Tricia Tan; Stephen Bloom


Expert Rev Clin Pharmacol. 2013;6(2):171-183. 

In This Article

Abstract and Introduction


Type 2 diabetes and obesity are intimately linked; reduction of bodyweight improves glycemic control, mortality and morbidity. Treating obesity in the diabetic is hampered as some diabetic treatments lead to weight gain. Bariatric surgery is currently the most effective antiobesity treatment and causes long-term remission of diabetes in many patients. However, surgery has a high cost and is associated with a significant risk of complications, and in practical terms only limited numbers can undergo this therapy. The choice of pharmacological agents suitable for treatment of diabetes and obesity is currently limited. The glucagon-like peptide-1 receptor agonists improve glycemia and induce a modest weight loss, but there are doubts over their long-term safety. New drugs such as lorcaserin and phentermine/topiramate are being approved for obesity and have modest, salutary effects on glycemia, but again long-term safety is unclear. This article will also examine some future avenues for development, including gut hormone analogues that promise to combine powerful weight reduction with beneficial effects on glucose metabolism.


According to the International Diabetes Federation, Type 2 diabetes had a worldwide prevalence of 366 million in 2011. This is predicted to rise to 552 million by 2030.[201] There is a well-known close association between Type 2 diabetes and obesity frequently expressed by the term 'diabesity'.[1] It is currently challenging to treat coexistent Type 2 diabetes and obesity because some antidiabetic agents, including thiazolidinediones (TZDs), insulin and sulphonylureas (SUs), are associated with weight gain, meaning that Type 2 diabetics are at risk of a vicious circle of increasing weight and increasing insulin resistance, thus requiring further intensification of glycemic treatment.

In this report, the authors will examine the role of current diabetes treatments on weight, together with the impact of newly introduced treatments for obesity on comorbid diabetes. The authors will then discuss the potential promise that gut hormone-based strategies hold for the treatment of diabesity.