Obesity Management for Treatment of Type II Diabetes
2016 ADA Guideline Recommendations |
Types of Diabetes Mellitus |
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2016 ADA Standard of Medical Care Guideline Recommendations |
Cardiovascular Disease and Risk Management |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Shivani Chaparala M.B.B.S [2]; Seyedmahdi Pahlavani, M.D. [3]; Tarek Nafee, M.D. [4]
2016 ADA Standards of Medical Care in Diabetes Guidelines
ASSESSMENT
"1. At each patient encounter, BMI should be calculated and documented in the medical record. (Level of Evidence: B)" |
DIET,PHYSICAL ACTIVITY, AND BEHAVIORAL THERAPY
"1. Diet, physical activity, and behavioral therapy designed to achieve 5% weight loss should be prescribed for overweight and obese patients with type 2 diabetes ready to achieve weight loss. (Level of Evidence: A)" |
"2. Such interventions should be high in- tensity ($16 sessions in 6 months) and focus on diet, physical activity, and behavioral strategies to achieve a 500–750 kcal/day energy deficit. (Level of Evidence: A)" |
"3. Diets that provide the same caloric restriction but differ in protein, carbohydrate, and fat content are equally effective in achieving weight loss. (Level of Evidence: A)" |
"4. For patients who achieve short- term weight loss goals, long-term ($1-year) comprehensive weight maintenance programs should be prescribed. Such programs should provide at least monthly contact and encourage ongoing monitoring of body weight (weekly or more fre- quently), continued consumption of a reduced calorie diet, and par- ticipation in high levels of physical activity (200–300 min/week). (Level of Evidence: A)" |
"5. To achieve weight loss of .5%, short-term (3-month) high-intensity lifestyle interventions that use very low-calorie diets (#800 kcal/day) and total meal replace- ments may be prescribed for carefully selected patients by trained practitioners in medical care settings with close medical monitoring. To maintain weight loss, such programs must incorpo- rate long-term comprehensive weight maintenance counseling. (Level of Evidence: B)" |
PHARMACOTHERAPY
"1. When choosing glucose-lowering medications for overweight or obese patients with type 2 diabetes, consider their effect on weight. (Level of Evidence: E)" |
"2. Whenever possible, minimize the medications for comorbid condi- tions that are associated with weight gain. (Level of Evidence: E)" |
"3. Weight loss medications may be effective as adjuncts to diet, physical activity, and behavioral counseling for selected patients with type 2 di- abetes and BMI $27 kg/m2. Potential benefits must be weighed against the potential risks of the medications. (Level of Evidence: A)" |
"4. If a patient’s response to weight loss medications is ,5% after 3 months or if there are any safety or tolerabil- ity issues at any time, the medication should be discontinued and alterna- tive medications or treatment ap- proaches should be considered. (Level of Evidence: A)" |
BARIATRIC SURGERY
"1. Bariatric surgery may be considered for adults with BMI .35 kg/m2 and type 2 diabetes, especially if diabe- tes or associated comorbidities are difficult to control with lifestyle and pharmacological therapy. (Level of Evidence: B)" |
"2. Patients with type 2 diabetes who have undergone bariatric surgery need lifelong lifestyle support and annual medical monitoring, at a minimum. (Level of Evidence: B)" |
"3. Although small trials have shown a glycemic benefit of bariatric sur- gery in patients with type 2 dia- betes and BMI 30–35 kg/m2, there is currently insufficient evi- dence to generally recommend surgery in patients with BMI #35 kg/m2. (Level of Evidence: E)" |