Steven R. Smith, MD


July 12, 2013

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Attacking Diabetes Through Weight Management

Hello. I am Dr. Steven Smith, Scientific Director of the Translational Research Institute at Florida Hospital and Professor at the Sanford-Burnham Medical Research Institute in Orlando, Florida. I'm at the American Diabetes Association (ADA) scientific sessions in Chicago.

I wanted to talk about recent trends in how we manage our patients with diabetes. We now have many classes of medications to treat diabetes -- to control blood sugar. We all know of the effectiveness of lifestyle intervention, diet and exercise, both in the treatment of diabetes and in the prevention of diabetes. One emerging trend that we are seeing is an increasing emphasis on weight management in our patients with type 2 diabetes. What am I talking about here? Weight is the genesis of many of our cases of type 2 diabetes, and the uptick in diabetes has been due largely to the increasing obesity epidemic in the United States and across the Western world.

With obesity as a fundamental pathobiology of how diabetes develops, it makes a lot of sense to attack that pathobiology through weight management. Historically, we have focused on glycemic management, and as we look at the past 5 or 10 years in diabetes drug development and the agents that are coming onto the market for treating diabetes, we see an increasing emphasis on the ability of diabetes medications to not only control glycemia but also to help reduce body weight. I call that "diabetes plus." We would like to see diabetes drugs that not only improve glucose but reduce microvascular complications, modify the progression of the beta-cell dropout that occurs in type 2 diabetes, or have weight management properties.

Drugs With a One-Two Punch

We have 2 new approved obesity drugs in the United States that have been released and are on the market. In the pivotal studies of those medications, patients with diabetes showed very nice improvements in glycemia but also improvements in other cardiometabolic risk factors, such as cholesterol; improvements in insulin sensitivity; and reductions in many other cardiovascular risk factors. We are seeing an increased emphasis on weight management in diabetes because of these available pharmacotherapies for obesity that can be used in patients with diabetes and other approaches that can supplement our more traditional medications for diabetes.

Physical activity can help increase the effectiveness of diabetes drugs through improving insulin sensitivity and reducing insulin use. Just a 5%-10% change in body weight can reduce the number of diabetes medications that a patient has to take, while at the same time improving cardiometabolic risk factors.

As we look over the horizon -- and a lot of work was presented here at the ADA meeting in Chicago on this topic -- we are going to see much more emphasis on weight management in patients with type 2 diabetes to supplement the medications that we already know and use in our clinical practice. We will also be setting a new paradigm for how we think about treating type 2 diabetes.

From the ADA meeting in Chicago, thanks for your attention, and I look forward to seeing you again on Medscape soon.


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