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Exp Clin Endocrinol Diabetes 2021; 129(S 01): S44-S51
DOI: 10.1055/a-1284-6050
German Diabetes Association: Clinical Practice Guidelines

Obesity and Diabetes

Jens Aberle
1   Section Endocrinology and Diabetology, University Obesity Centre Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
Anne Lautenbach
1   Section Endocrinology and Diabetology, University Obesity Centre Hamburg, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
Svenja Meyhöfer
2   Institute for Endocrinology & Diabetes, University of Lübeck, Department of Internal Medicine 1, Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
,
Sebastian M. Schmid
2   Institute for Endocrinology & Diabetes, University of Lübeck, Department of Internal Medicine 1, Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
,
Lars Selig
3   Nutrition Team/Nutrition Outpatient Clinic, University Hospital Leipzig, Leipzig, Germany
,
Matthias Blüher
4   Medical Department III - Endocrinology, Nephrology, Rheumatology, University of Leipzig, Leipzig, Germany
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Weight reduction is an integral part of the therapy of many patients with type 2 diabetes. The effectiveness of weight reduction in the treatment and prevention of type 2 diabetes has been proven by many studies. In the “Finnish Diabetes Prevention Study”, the conversion of prediabetes to type 2 diabetes was reduced by 58% through lifestyle intervention [1]. Similar results were obtained in the “Diabetes Prevention Program” [2]. An English study showed that for every 1 kg of weight lost in the first year after diagnosis of type 2 diabetes, life expectancy increases by 3−4 months [3], and Williamson et al. [4] showed that a weight reduction of 10 kg reduces overall mortality in people with type 2 diabetes by 25%. In addition, weight reduction not only improves blood glucose levels, but also virtually all comorbidities of diabetes simultaneously (hypertension, fatty liver disease, depression, obstructive sleep apnea syndrome [OSAS], etc.). However, these effects appear to be particularly strong when a weight reduction of at least 5% can be achieved [5]. Weight gain in type 2 diabetes treatment worsens cardiovascular risk factors and is associated with an increase in cardiovascular events and mortality [6].

From the 2018 consensus report of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) and the 2019 update [7], it is clear that self-managed lifestyle intervention with weight reduction is of major importance in the treatment of type 2 diabetes. As a general treatment goal, patients with obesity and diabetes should aim for weight stabilization in the range of the normal weight (BMI 18.5−24.9 kg/m2).

Since both an increased abdominal subcutaneous and visceral fat mass are associated with insulin resistance, measurement of waist circumference also serves as a good indicator of metabolic and cardiovascular risk and helps in the assessment of effective weight loss [8]. The BMI is also considered an independent predictor of cardiovascular events. However, waist circumference seems to be a better indicator of cardiovascular risk than BMI [9]. Women with a waist circumference≥80 cm and men with≥94 cm should not gain any further weight ([Table 1]).

Table 1 General therapy goals for long-term weight stabilization.

Indicator

General therapy goal

BMI

18.5−24.9 kg/m2

Waist circumference for women

≤80 cm

Waist circumference for men

≤94 cm

If the waist circumference is already at ≥88 cm for women and at ≥102 cm for men, the body weight should be reduced [9].

People with diabetes and a BMI of ≥25 kg/m2 should aim to lose weight. At least 5% of the initial body weight should be lost within 6−12 months. This reduction of 5% already leads to a significant improvement in blood glucose levels. In people with diabetes and a BMI≥35 kg/m2, the goal of weight reduction should be at least 10% of the starting weight. Once the weight reduction goals have been achieved, the treatment aims at long-term weight stabilization.



Publication History

Article published online:
22 December 2020

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  • References

  • 1 Lindström J, Louheranta A, Mannelin M. et al. Finnish Diabetes Prevention Study Group. The Finnish Diabetes Prevention Study (DPS): lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 2003; 26: 3230-3236
    CrossrefPubMedGoogle Scholar
  • 2 Knowler WC, Barrett-Connor E, Fowler SE. et al. Diabetes Prevention Program Research G: Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403
    CrossrefPubMedGoogle Scholar
  • 3 Lean ME, Powrie JK, Anderson AS. et al. Obesity, weight loss and prognosis in type 2 diabetes. Diabet Med 1990; 7: 228-233
    CrossrefPubMedGoogle Scholar
  • 4 Williamson DF, Thompson TJ, Thun M. et al. Intentional weight loss and mortality among overweight individuals with diabetes. Diabetes Care 2000; 23: 1499-1504
    CrossrefPubMedGoogle Scholar
  • 5 Look ARG, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med 2010; 170: 1566-1575
    PubMedGoogle Scholar
  • 6 Eeg-Olofsson K, Cederholm J, Nilsson PM. et al. Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: an observational study in 13,087 patients. Diabetologia 2009; 52: 65-73
    CrossrefPubMedGoogle Scholar
  • 7 Buse JB, Wexler DJ, Tsapas A. et al. 2019 Update to: Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2020; 43: 487-493
    CrossrefPubMedGoogle Scholar
  • 8 Wang Z, Hoy WE. Waist circumference, body mass index, hip circumference and waist-to-hip ratio as predictors of cardiovascular disease in Aboriginal people. Eur J Clin Nutr 2004; 58: 888-893
    CrossrefPubMedGoogle Scholar
  • 9 Pischon T, Boeing H, Hoffmann K. et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359: 2105-2120
    CrossrefPubMedGoogle Scholar
  • 10 German Nutrition Society (DGE) e.V. Eat and drink wholefood according to the 10 rules of the DGE. 2017 https://www.dge.de/nutritional practice/full-fledged nutrition/10-rules of the DGE/
    PubMed
  • 11 German Obesity Society (DAG) e. V.; German Diabetes Society (DDG); German Society for Nutrition (DGE) e. V.; German Society for Nutritional Medicine (DGEM). Interdisciplinary Quality Guideline S3 for “Prevention and Therapy” of Obesity - Long Version. German Medical Association (BÄK); National Association of Statutory Health Insurance Physicians (KBV); Association of Scientific Medical Societies (AWMF). 2014
    PubMed
  • 12 Lean MEJ, Han TS, Morrison CE. Waist circumference as a measure for indicating need for weight management. BMJ 1995; 311: 158-161
    CrossrefPubMedGoogle Scholar
  • 13 Evert AB, Dennison M, Gardner CD. et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care 2019; 42: 731-754
    CrossrefPubMedGoogle Scholar
  • 14 Reynolds AN, Akerman AP, Mann J. Dietary fibre and whole grains in diabetes management: Systematic review and meta-analyses. PLoS Med 2020; 17: e1003053
    CrossrefPubMedGoogle Scholar
  • 15 Landgrave R, Aberle J, Birkenfeld AL. et al. Therapy of type 2 diabetes. Diabetologie 2019; 14: 144-167
    PubMedGoogle Scholar
  • 16 Lean ME, Leslie WS, Barnes AC. et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, clusterrandomised trial. Lancet 2018; 391: 541-551
    CrossrefPubMedGoogle Scholar
  • 17 Gregg EW, Chen H, Wagenknecht LE. et al. Association of an Intensive Lifestyle Intervention With Remission of Type 2 Diabetes. JAMA 2012; 308: 2489
    CrossrefPubMedGoogle Scholar
  • 18 National Care Guideline Therapy of Type 2 Diabetes. - Long version. 2020; 1st edition. Version 4. https://doi.org/10.6101/AZQ/000213
    PubMed
  • 19 Kay SJ, Fiatarone Singh MA. The influence of physical activity on abdominal fat: a systematic review of the literature. Obes Rev 2006; 7: 183-200
    CrossrefPubMedGoogle Scholar
  • 20 Piercy KL, Troiano RP, Ballard RM. et al. The Physical Activity Guidelines for Americans. JAMA 2018; 320: 2020
    CrossrefPubMedGoogle Scholar
  • 21 van Can J, Sloth B, Jensen CB. et al. Effects of the once-daily GLP-1 analog liraglutide on gastric emptying, glycemic parameters, appetite and energy metabolism in obese, non-diabetic adults. Int J Obes (Lond) 2014; DOI: 10.1038/ijo.2013.162.
    CrossrefPubMedGoogle Scholar
  • 22 Efficacy of Liraglutide for Weight Loss Among Patients With Type 2 Diabetes The SCALE Diabetes Randomized Clinical Trial. JAMA 2015; 314: 687-699
    CrossrefPubMedGoogle Scholar
  • 23 Pi-Sunyer X, Astrup A, Fujioka K. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med 2015; 373: 11-22
    CrossrefPubMedGoogle Scholar
  • 24 Golay A. Metformin and body weight. Int J Obes 2008; 32: 61-72
    CrossrefPubMedGoogle Scholar
  • 25 O’Neil PM, Birkenfeld AL, McGowan B. et al. Efficacy and safety of semaglutide compared with liraglutide and placebo for weight loss in patients with obesity: a randomised, double-blind, placebo and active controlled, dose-ranging, phase 2 trial. Lancet 2018; 392: 637-649
    CrossrefPubMedGoogle Scholar
  • 26 Frias JP, Nauck MA, Van J. et al. Efficacy and safety of LY3298176, a novel dual GIP and GLP-1 receptor agonist, in patients with type 2 diabetes: a randomised, placebo-controlled and active comparator-controlled phase 2 trial. Lancet 2018; 392: 2180-2193
    CrossrefPubMedGoogle Scholar
  • 27 Rubino F, Nathan DM, Eckel RH. et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care 2016; 39: 861-877
    CrossrefPubMedGoogle Scholar
  • 28 S3 guideline: Surgery for obesity and metabolic diseases. 2018 https://www.awmf.org/uploads/tx_szleitlinien/088-001l_S3_ Surgery-Adiposity-metabolic diseases_2018-02.pdf
    PubMed
  • 29 Flum DR, Belle SH, King WC. et al. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 2009; 361: 445-445
    CrossrefPubMedGoogle Scholar
  • 30 Birkmeyer NJ, Dimick JB, Share D. et al. Michigan Bariatric Surgery Collaborative. Hospital complication rates with bariatric surgery in Michigan. JAMA 2010; 304: 435-444
    CrossrefPubMedGoogle Scholar
  • 31 Aberle J, Reining F, Klinge A. et al. Metformin After Bariatric Surgery - an Acid Problem. Exp Clin Endocrinol Diabetes 2012; 120: 152-153
    Article in Thieme ConnectPubMedGoogle Scholar