Weight Loss and the Prevention and Treatment of Type 2 Diabetes Using Lifestyle Therapy, Pharmacotherapy, and Bariatric Surgery: Mechanisms of Action

  title={Weight Loss and the Prevention and Treatment of Type 2 Diabetes Using Lifestyle Therapy, Pharmacotherapy, and Bariatric Surgery: Mechanisms of Action},
  author={Jayleen M. Grams and W. Timothy Garvey},
  journal={Current Obesity Reports},
Weight loss, whether achieved by lifestyle intervention, pharmacotherapy, or bariatric surgery, is highly effective as a primary interventional strategy in both the prevention and treatment of type 2 diabetes. In high-risk patients with prediabetes and/or metabolic syndrome, weight loss effectively prevents progression to type 2 diabetes mellitus (T2DM) and improves cardiovascular risk factors. These benefits are the result of improvements in insulin resistance, which is central to the… 
Diet and prevention of type 2 diabetes mellitus: beyond weight loss and exercise
Dietary factors showing promise for reducing type 2 diabetes mellitus risk include higher intakes of cereal fibers, unsaturated fatty acids, magnesium, and polyphenols, while reducing dietary glycemic load, added sugars, and high-sugar beverages.
Ablation of the Duodenal Mucosa as a Strategy for Glycemic Control in Type 2 Diabetes: Role of Nutrient Signaling or Simple Weight Loss
The authors present a 6-month interim analysis of a phase I, single-arm, nonrandomized cohort study assessing safety and efficacy of endoscopic duodenal mucosal resurfacing (DMR) for treatment of T2D.
The Effectiveness of Different Diet Strategies to Reduce Type 2 Diabetes Risk in Youth
A review of the current literature indicates that dietary interventions lead to weight loss when intervention adherence is high, and a diet that is reduced in carbohydrates may optimize improvements in other type 2 diabetes risk factors, including insulin resistance and hyperglycemia.
Normocaloric Diet Restores Weight Gain and Insulin Sensitivity in Obese Mice
Results indicate that obesity-related insulin resistance may be rescued by shifting from HFD to NCD, and a significant reduction of body weight was found after the transition from high to normal fat diet, and this decrease correlated well with an improvement in insulin sensitivity.
Combined insulin detemir and liraglutide therapy in type 2 diabetic patients: a base for an alliance
The different mechanistic actions of insulin detemir and liraglutide resulted in an additive glucose-lowering effect, which did not affect the pharmacodynamic and pharmacokinetic profiles of each therapeutic agent.
Dietary Strategies Implicated in the Prevention and Treatment of Metabolic Syndrome
D diets based on negative-energy-balance, the Mediterranean dietary pattern, n-3 fatty acids, total antioxidant capacity and meal frequency, and dietary fiber content are some of the most relevant aspects related to insulin resistance and impaired glucose tolerance, which are important co-morbidities of MetS.
Use and Impact of Type 2 Diabetes Prevention Interventions.
The aetiology and molecular landscape of insulin resistance.
Evidence is provided to support the view that insulin resistance is a heterogeneous disorder that may variably arise in a range of metabolic tissues and that the mechanism for this effect likely involves a unified insulin resistance pathway that affects a distal step in the insulin action pathway that is more closely linked to the terminal biological response.


Obesity and Diabetes: The Impact of Bariatric Surgery on Type-2 Diabetes
  • J. Dixon
  • Medicine
    World Journal of Surgery
  • 2009
Bariatric surgery should be considered for adults with BMI ≥ 35 kg/m2 and type-2 diabetes, especially if the diabetes is difficult to control with lifestyle and pharmacologic therapy, and choice of procedure requires a careful risk–benefit analysis for the individual patient.
Effects of bariatric surgery on glucose homeostasis and type 2 diabetes.
The effects of surgery on body weight and metabolic function indicate that bariatric surgery should be part of the standard therapy for type 2 diabetes mellitus.
Clinical efficacy of orlistat therapy in overweight and obese patients with insulin-treated type 2 diabetes: A 1-year randomized controlled trial.
Orlistat therapy produces clinically significant weight loss, with improvements in glycemic control and cardiovascular disease risk factors, in overweight or obese patients with type 2 diabetes who have suboptimal metabolic control with insulin therapy.
Role of Orlistat in the Treatment of Obese Patients With Type 2 Diabetes: A 1-year randomized double-blind study
Orlistat is an effective treatment modality in obese patients with type 2 diabetes with respect to clinically meaningful weight loss and maintenance of weight loss, improved glycemic control, and improved lipid profile.
The benefits of modest weight loss in type II diabetes.
Modest weight loss by patients with type II diabetes improves glycaemic control, insulin sensitivity and cardiovascular risk factors; and the risk of developing long-term diabetes-related complications may also be reduced by such metabolic improvements.
Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes.
An intensive lifestyle intervention focusing on weight loss did not reduce the rate of cardiovascular events in overweight or obese adults with type 2 diabetes.
Effect of weight loss by gastric bypass surgery versus hypocaloric diet on glucose and incretin levels in patients with type 2 diabetes.
Early after Gastric bypass surgery, the greater GLP-1 and GIP release and improvement of incretin effect are related not to weight loss but rather to the surgical procedure, which could be responsible for better diabetes outcome after GBP.
Prevention of Type 2 Diabetes in Subjects With Prediabetes and Metabolic Syndrome Treated With Phentermine and Topiramate Extended Release
PHEN/TPM ER plus lifestyle modification produced significant weight loss and markedly reduced progression to type 2 diabetes in overweight/obese patients with prediabetes and/or MetS, accompanied by improvements in multiple cardiometabolic disease risk factors.
XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients.
Compared with lifestyle changes alone, orlistat plus lifestyle changes resulted in a greater reduction in the incidence of type 2 diabetes over 4 years and produced greater weight loss in a clinically representative obese population.