Center for Metabolic Research, VA San Diego Healthcare System and University of California San Diego, San Diego, CA, USA.
J Diabetes Complications. 2013 Sep-Oct;27(5):508-18. doi: 10.1016/j.jdiacomp.2013.04.011. Epub 2013 May 28.
Moderate weight loss (>5%), which has been associated with improvements in glycemic parameters in patients with dysglycemia, also reduces the presence of other comorbidities, including dyslipidemia and hypertension, culminating in a reduced risk of cardiovascular disease. Lifestyle changes are the recommended preliminary approach to weight loss, with an initial weight-loss goal of 10% of body weight achieved over 6 months at a rate of 1-2 pounds per week selected as an appropriate target to decrease the severity of obesity-related risk factors. Implementing and maintaining the lifestyle changes associated with weight loss can, however, be challenging for many patients. Therefore, additional interventions sometimes may be necessary. Bariatric surgery can also be a highly effective option for weight loss and comorbidity reduction, but surgery carries considerable risks and is still applicable only to selected patients with type 2 diabetes. Thus, attention is turning to the use of weight-loss medications, including 2 recently approved compounds: twice-daily lorcaserin and a once-daily combination of phentermine and topiramate extended-release, both shown to be safe and effective therapies in the management of obesity in patients with type 2 diabetes.
适度减重（>5%）已被证实可改善糖代谢异常患者的血糖参数，同时也可减少其他合并症的发生，包括血脂异常和高血压，从而降低心血管疾病的风险。生活方式改变是推荐的初步减重方法，初始减重目标为体重的 10%，在 6 个月内以每周 1-2 磅的速度实现，这是一个降低肥胖相关危险因素严重程度的合适目标。然而，对于许多患者来说，实施和维持与减重相关的生活方式改变可能具有挑战性。因此，有时可能需要额外的干预措施。减重手术也可以是一种非常有效的减重和减少合并症的方法，但手术风险较高，并且仍然只适用于 2 型糖尿病的某些选定患者。因此，人们开始关注使用减肥药，包括最近批准的两种药物：每日两次的lorcaserin 和每日一次的 phentermine 和托吡酯缓释片的组合，这两种药物都被证明在 2 型糖尿病肥胖患者的管理中是安全有效的治疗方法。
