Pappachan Joseph M, Viswanath Ananth K
Department of Endocrinology and Diabetes, Royal Lancaster Infirmary, University Hospitals of Morecambe NHS Trust, Ashton Road, Lancaster, LA1 4RP, UK.
Department of Endocrinology and Diabetes, New Cross Hospital, The Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, WV10 0QP, UK.
Curr Diab Rep. 2017 Jan;17(1):4. doi: 10.1007/s11892-017-0828-9.
The global prevalence of "diabesity"-diabetes related to obesity-is increasing steadily over the past few decades because of the obesity epidemic. Although bariatric surgery is an effective treatment option for patients with diabesity, its limited availability, invasiveness, relatively high costs and the potential for surgical and postsurgical complications restrict its widespread use. Therefore, medical management is the only option for a majority of patients with diabesity. Diabetes control with several anti-diabetic agents, including insulin, causes weight gain with probability of worsening diabesity. Rational use of anti-diabetic medications with weight loss potential in varying combinations may help to address this key issue for long-term management of diabesity. There is no consensus on such an approach from different professional bodies like American Diabetes Association, European Association for Study of Diabetes, or International Diabetes Federation. We attempt to discuss the key issues and realistic targets for diabesity management in this paper.
Rational use of anti-diabetic combinations can mitigate worsening of diabesity to some extent while managing patients. Retrospective studies showed that combination therapy with glucagon-like peptide-1 (GLP-1) receptor agonists and sodium glucose co-transporter 2 (SGLT-2) inhibitors, when administered along with other anti-diabetic medications, offer the best therapeutic benefit in the medical management of diabesity. Different combinations of other anti-diabetic drugs with minimum weight gain potential were also found useful. Because of insufficient evidence based on prospective randomised controlled trials (RCTs), future research should focus on evolving the appropriate rational drug combinations for the medical management of diabesity.
在过去几十年里，由于肥胖症的流行，“糖尿病肥胖症”（与肥胖相关的糖尿病）的全球患病率一直在稳步上升。尽管减肥手术是治疗糖尿病肥胖症患者的有效选择，但其可用性有限、具有侵入性、成本相对较高以及存在手术和术后并发症的风险，限制了其广泛应用。因此，药物治疗是大多数糖尿病肥胖症患者的唯一选择。使用包括胰岛素在内的多种抗糖尿病药物来控制糖尿病会导致体重增加，从而有可能使糖尿病肥胖症恶化。合理使用具有潜在减肥作用的抗糖尿病药物并进行不同组合，可能有助于解决糖尿病肥胖症长期管理中的这一关键问题。美国糖尿病协会、欧洲糖尿病研究协会或国际糖尿病联合会等不同专业机构对于这种方法尚未达成共识。我们试图在本文中讨论糖尿病肥胖症管理的关键问题和现实目标。
合理使用抗糖尿病药物组合在治疗患者的同时，可在一定程度上减轻糖尿病肥胖症的恶化。回顾性研究表明，胰高血糖素样肽-1（GLP-1）受体激动剂和钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂与其他抗糖尿病药物联合使用时，在糖尿病肥胖症的药物治疗中能提供最佳治疗效果。还发现其他具有最小体重增加潜力的抗糖尿病药物的不同组合也很有用。由于前瞻性随机对照试验（RCT）的证据不足，未来的研究应侧重于为糖尿病肥胖症的药物治疗开发合适的合理药物组合。
