Obesity Management for Treatment of Type II Diabetes
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2016 ADA Guideline Recommendations |
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Types of Diabetes Mellitus |
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2016 ADA Standard of Medical Care Guideline Recommendations |
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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]; Tarek Nafee, M.D. [3]
2016 ADA Standards of Medical Care in Diabetes Guidelines[1]
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 frequently), continued consumption of a reduced calorie diet, and participation 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 replacements 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 incorporate 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 conditions 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 diabetes 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 tolerability issues at any time, the medication should be discontinued and alternative medications or treatment approaches 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 diabetes 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 surgery in patients with type 2 diabetes and BMI 30–35 kg/m2, there is currently insufficient evidence to generally recommend surgery in patients with BMI ≤ 35 kg/m2. (Level of Evidence: E)" |
References
- ↑ "care.diabetesjournals.org" (PDF).