Treatment of Type 2 Diabetes in Subjects with Obesity: What is the Best Approach?

E. Monti, A. Rebora, E. Torre, M. Albertelli, C. Campana, F. Gatto, D. Ferone
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Abstract

Prevalence of both obesity and type 2 diabetes (T2DM) is increasing worldwide. Obesity, along with insulin resistance, predisposes individuals to low-grade chronic inflammation. Moreover, the combination of insulin resistance and hyperinsulinemia gives rise to the metabolic syndrome. The management of obesity can delay the progression to diabetes and first line treatment is represented by interventions on lifestyle (low-calorie diet and aerobic exercise). In obese patients with T2DM, weight loss improves glycaemic control and, therefore, reduces the antidiabetic drug need. While some older medications, including insulin, result in weight gain, the new molecules (glucagon-like peptide receptors agonists [GLP-1ra] and sodium-glucose co-transporter 2 inhibitors [SGLT2i]) result in weight loss. GLP-1ra has an anorexic action because it slows emptying gastric, whereas SGLT2i induce glycosuria by an osmotic diuresis associated with a loss of water. To date, metformin is used as a first-line anti-diabetic drug. This molecule is known to reduce hepatic gluconeogenesis, to decrease intestinal absorption of glucose and to improve peripheral glucose uptake. In obese patients with insulin resistance metformin can correct this alteration and promote weight loss. the same disease, the metabolic syndrome. Metformin is the first-line therapy in T2DM for its tolerability and efficacy in reducing glycated hemoglobin. Thanks to their different mechanism of action, metformin in association with GLP-1ra and/or SGLT2i probably represent the best choice for obese patients with T2DM.
2型糖尿病肥胖患者的治疗:什么是最好的方法?
肥胖症和2型糖尿病(T2DM)的患病率在全球范围内呈上升趋势。肥胖,加上胰岛素抵抗,使个体容易患上低度慢性炎症。此外,胰岛素抵抗和高胰岛素血症的结合引起代谢综合征。肥胖的管理可以延缓糖尿病的进展,一线治疗是通过干预生活方式(低热量饮食和有氧运动)。在肥胖的T2DM患者中,体重减轻可以改善血糖控制,从而减少抗糖尿病药物的需求。虽然一些较老的药物,包括胰岛素,会导致体重增加,但新的分子(胰高血糖素样肽受体激动剂[GLP-1ra]和钠-葡萄糖共转运蛋白2抑制剂[SGLT2i])会导致体重减轻。GLP-1ra具有厌食作用,因为它减缓胃排空,而SGLT2i通过渗透性利尿和失水诱导糖尿。迄今为止,二甲双胍被用作一线抗糖尿病药物。已知该分子可减少肝脏糖异生,减少肠道对葡萄糖的吸收,并改善外周葡萄糖摄取。对于胰岛素抵抗的肥胖患者,二甲双胍可以纠正这种改变并促进体重减轻。同样的疾病,代谢综合症。二甲双胍因其耐受性和降低糖化血红蛋白的疗效而成为T2DM的一线治疗药物。由于其不同的作用机制,二甲双胍联合GLP-1ra和/或SGLT2i可能是肥胖T2DM患者的最佳选择。
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