The challenge of managing coexistent type 2 diabetes and obesity.

Coexistent type 2 diabetes and obesity—often termed “diabesity”—is an emerging epidemic that poses a challenge to the treatment of both conditions.More than 90% of the world’s 285 million people with diabetes have type 2 diabetes, and this number is projected to grow to 438 million by 2030. In North America about 90% of people with type 2 diabetes are obese (body mass index >30 (weight (kg)/height (m))), overweight (body mass index 25-29.9), or have a medical history of being so, and those who are not overweight may carry an excess of hidden visceral fat. A large cohort study estimated that a body mass index of 30-34.9 (compared with 22) for 16 years increased the risk of type 2 diabetes more than 20-fold in women, and a large cross sectional study of North American men aged 25-54 estimated that a body mass index of 30-34.9 increased the risk more than 10-fold. w2 In principle, lifestyle measures such as diet and exercise could prevent the onset and greatly help the treatment of type 2 diabetes and obesity. In practice this is seldom borne out. Few of the current treatments for type 2 diabetes facilitate weight loss, and some cause weight gain (table 1). Because excess adiposity presents a considerable hurdle to the control of hyperglycaemia, therapeutic approaches that simultaneously deal with glycaemic control and weight management are particularly attractive for the treatment of type 2 diabetes. This article examines existing and new treatments that have the potential to treat coexistent diabetes and obesity and explores the evidence from recent randomised trials and early experimental research. How do diabetes and obesity interact?