Division of Endocrinology, Department of Internal Medicine and Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Medicine (St Vincent's Hospital), University of Melbourne, Melbourne, VIC, Australia; Department of Endocrinology, Austin Health, Melbourne, VIC, Australia.
Lancet. 2022 Jan 22;399(10322):394-405. doi: 10.1016/S0140-6736(21)01919-X. Epub 2021 Sep 30.
Obesity is now recognised as a disease that is associated with serious morbidity and increased mortality. One of its main metabolic complications is type 2 diabetes, as the two conditions share key pathophysiological mechanisms. Weight loss is known to reverse the underlying metabolic abnormalities of type 2 diabetes and, as such, improve glucose control; loss of 15% or more of bodyweight can have a disease-modifying effect in people with type 2 diabetes, an outcome that is not attainable by any other glucose-lowering intervention. Furthermore, weight loss in this population exerts benefits that extend beyond glycaemic control to improve risk factors for cardiometabolic disease and quality of life. We review the evidence supporting the role of weight loss in the management of type 2 diabetes and propose that many patients with type 2 diabetes would benefit from having a primary weight-centric approach to diabetes treatment. We discuss the logistical challenges to implementing a new weight-centric primary treatment goal in people with type 2 diabetes.
肥胖现在被认为是一种与严重发病率和死亡率增加相关的疾病。其主要代谢并发症之一是 2 型糖尿病，因为这两种疾病具有共同的关键病理生理机制。众所周知，体重减轻可以逆转 2 型糖尿病潜在的代谢异常，并改善血糖控制；在 2 型糖尿病患者中，体重减轻 15%或更多可产生疾病改善的效果，这是任何其他降血糖干预都无法达到的。此外，该人群的体重减轻不仅能改善血糖控制，还能改善心血管代谢疾病的风险因素和生活质量，带来益处。我们回顾了支持体重减轻在 2 型糖尿病管理中作用的证据，并提出许多 2 型糖尿病患者将受益于将体重作为主要治疗目标的新方法。我们讨论了在 2 型糖尿病患者中实施新的以体重为中心的主要治疗目标所面临的实际挑战。
