Diabesity manchester march 2014

Action on Diabesity

Dr C Rajeswaran

Consultant Physician ( Diabetes, Obesity & Endocrinology)

Chair, National Diabesity Forum

Director, simplyweight Ltd

Diabesity - 21st century pandemic

Diabesity is now the single greatest contributor to chronic disease

Diabesity describes the twin epidemic of obesity and diabetes that we are facing throughout the world.

Imagine having "diabesity" and being addicted to

alcohol, caffeine nicotine......................“Alconicocafdiabesity?"

Multi hormone control of body weight:

Fat,gut and islets derived signals

Obesity and overweight .. conditions in which body fat has accumulated to such an extent that health may be adversely affected (WHO, 2000)

Adjusted odds ratio for death, by metabolic category for 51-61years age group

Diabetes 2.63

Obesity 0.78

Obesity and diabetes 6.81

Oldridge et al, Jr of clinical Epidemiology 54(2001);928-934

Weight gain in patients with type 2 diabetes can contribute to patient frustration and may negatively impact their compliance to therapeutic regimens.

F. Xavier Pi-Sunyer, Postgraduate Medicine: Volume 121: No.5The Impact of Weight Gain on Motivation, Compliance, and Metabolic Control in Patients with Type 2 Diabetes Mellitus

Glycaemic control and body weight

Weight gain appears unavoidable when patients with Type 2 diabetes are commenced on insulin

Body weight increases by 2Kg for each percentage point decrease in HbA1C during the first year1

.

1.Makimattila et al Diabetologia 1999;42;406-412

Diabesity-Management?

Potential benefits of 10kg weightloss in individuals of 100kg

Diabesity Team

Endocrinologist

Diabesity Nurse specialist

Dietitian

Physiotherapist

occupational therapists

Social worker

Psychologists

Bariatric surgeon

Evaluation:

Detailed History

Perception

Motivation

Hunger pattern

Body image

Glycaemic excursion

Evaluation:Psychological state

Anthropometry

Problems with ADL (activities of daily living)

Mobility

Sleep study

Endocrine abnormality

Evaluation:In addition to evaluating complications of diabetes, Obesity related complications are assessed

WHY ARE YOU EATING SO FAST?

I WANT TO EAT AS MUCH AS POSSIBLE

BEFORE I LOSE MY APPETITE!!

Brain Reward System

Control of appetite

Genes and Weight

Genes

Environment

40%60%

Drug Class May cause Weight gain Less weight gain, weight loss or weight neutral

Antipsychotics ClozapineRisperidoneOlanzipine

ZiprasidoneAripiprazole

Antidepressants and Mood stabilizers

CitalopramLithiumMAOIsTCAsVenlafaxineMirtazapineParoxetine

BupropionSertralineFluoxetine

Anticonvulsants CarbamazepineGabapentinValproate

LamotrigineTopiramate

Diabetes Drugs InsulinSulphonylureasThiazolidinediones

MetforminAcarboseGLP-1DDPIV

Antihypertensives Alpa blockersBeta blockers

ACE inhibitorsCalcium Channel Blockers

Oral Contraceptives Progesterone only pillCombination pill with progesterone

Barrier methodIUDs

Understanding Hunger Pattern

NEAT: Non exercise activity thermogenesis

Dieting cause weight gain

Surgery Effective Early Intervention for

Diabesity

Gastric balloon

http://www.healthierweight.co.uk/obesity-surgery/gastric-band/what-is-a-gastric-band/how-does-the-band-work/

Gastric Banding

SA 46 years male

Type 2 Diabetes (2002)

Morbid Obesity

Metformin 2.5 gms

Insulin 180 units

Examination:

Weight 164Kg (25.82 Stones)

Rest of examination unremarkable

Child hood……..

Puberty………

Family………

Social history……..

Personal history……..

H/O weight loss management & medical history

Investigations:

No evidence of Obstructive sleep apnoea

HbA1c-11.2%

Testosterone 6 nmol/l

SHBG 26

LH 2.1

FSH 1.3

Management

Testosterone 5gm gel OD

Calorie restriction

Clinic follow up

Weight 148 Kg (Initial wt 164)

NOT tired, No day time sleepiness

Insulin160 units a day

HbA1c 10.2%

Exenatide introduced

And

Insulin gradually weaned off

Under very close supervision

Clinic( 6 months)

119Kg (Initial wt -164Kg)

HbA1c - 8%

•Not every option is appropriate for every individual.

•Holistic approach is the key in a DIABESITY Clinic

Glycaemic control

Body weight and hunger pattern

Psychological issues

Underlying endocrine abnormalities

“ Of course doughnuts are good for you.

They’re HOLE grain!”

Thank you!