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Joslin Diabetes CenterPrimary Care Congress for Cardiometabolic Health 2013Long-Term Weight Management in Obese Patients With Diabetes
Long‐term Weight Management in Obese Diabetic Patients
Osama Hamdy, MD, PhD, FACE
Medical Director, Obesity Clinical Program,Director of Inpatient Diabetes Management,Joslin Diabetes CenterAssistant Professor of MedicineHarvard Medical SchoolBoston, Massachusetts, USA
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Obesity and Diabetes: the Twin Epidemics
Rates of diabetes and obesity are dramatically high worldwide,with an average of
OECD (2011), “Overweight and obesity among adults”, in Health at a Glance 2011: OECD Indicators, OECD Publishing. http://dx.doi.org/10.1787/health_glance-2011-18-enOECD (2011), “Diabetes prevalence and incidence”, in Health at a Glance 2011: OECD Indicators, OECD Publishing. http://dx.doi.org/10.1787/health_glance-2011-13-en
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Nu
mb
er in
Mil
lion
s
CDC/NCHS, National Health and Nutrition Examination Survey, 2009–2010
Number of US Individuals with Obesity
37.5
5.5
40.6
7
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
Age >20 ys Age 2-19
WomenMen
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1‐ Can long‐term weight loss be achieved?
2‐What are the keys for long‐term maintenance of weight loss?
3‐ Is non‐surgical weight reduction cost‐effective?
4. Medication adjustment and frequent BG monitoring
5. Counseling and cognitive behavioral change
6. Group intervention and frequent participant contact
7. Daily weighing 14
Effect of weight loss on insulin sensitivity
Weight Insulin Sensitivity
BMI = body mass index; W/H = waist-to-hip-ratio.
*P<0.001Hamdy O, et al. Diabetes Care. 2003;26:2119-2125
Chan
ge From Baseline (%
)
BMI W/H
* * *
*
1‐ Aim for Modest Weight Loss through Defining a SMART Goal
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Visceral FatVisceral Fat
BP & lipids BP & lipids
Metabolic ControlPhysical Fitness & QOLMaintenance of Weight Loss
Metabolic ControlPhysical Fitness & QOLMaintenance of Weight Loss
Vascular ResistanceVascular Resistance
The benefits of Exercise and or
Increased Physical Activity include
2‐ Gradual, balanced and individualized physical activity‐ Duration of exercise‐ Type of exercise‐ Short versus long‐bouts of exercise‐ Exercise records/exercise monitor
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Diabetes, a Common Comorbidity, Significantly Accelerates Loss of Muscle Mass, Strength and Quality
p<0.05*Park SW, et al. Diabetes Care 2009;32:1993-1997.
Loss of Total Muscle Mass[g/ year]
Loss of Muscle M
ass (gm
/year)
*
*
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Loss of Muscle M
ass
(As % of Total W
eight Loss)
Men
Women
*P<0.05
Ballor DL and Poehlman ET. Int J Obes Relat Metab Disord. 1994;18(1):35-40.
Exercise Preserves Muscle Mass During Weight Reduction
Diet Diet + Exercise
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Balanced Exercise Model
Flexibility Strength
Strength exercise is particularly important during weight reduction
Aerobic
Walking
Swimming
Biking
Dancing
Resistance tubing
Weight lifting
Yoga
Stretching
Yoga
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Joslin Diabetes CenterPrimary Care Congress for Cardiometabolic Health 2013Long-Term Weight Management in Obese Patients With Diabetes
Cost‐effectiveness of Intensive Lifestyle Intervention
A 10‐year analysis of the Diabetes Prevention Program trial showed lifestyle intervention was cost‐effective compared with placebo in prevention of diabetes in high‐risk adults
From a payer perspective, investment in lifestyle management for diabetes prevention provides good value
The Diabetes Prevention Program Research Group. Diabetes Care. 2012;35:723-730.
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Economic Impact of Non‐Surgical Weight Loss in One Year in Patients With Diabetes
Cost Saving(1% wt loss)
Cos
t sav
ing
per y
ear
(-3.6%)1*
(-5.8%)2*
(-27%)
(-44%)
Estimated Saving with(7% wt loss)
1) p<0.5 2) p<001
YU AP et al. Curr Med Res Opin. 2007;23(9):2157-69
Health Care Cost Diabetes Related Cost
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Impact of Bariatric Surgery on Healthcare Utilization & Costs in Patients with DM over 6 Years
Odds of Hospitalization Ratio of Counts of PCP Visits
Ratio of Counts of Specialist
ConclusionIn the six years following bariatric surgery, individuals with type 2 diabetes did not have lower healthcare costs than before surgery.
Bleich SN et al. Med Care. 2012, 50(1):58-65
7,806 patients with diabetes who received bariatric surgery
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In Conclusion
Long-term weight reduction can be achieved through non-surgical weight management
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Exercise type and duration significantly impact long-term weight maintenance
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Changing macronutrient compositions, providing structured meal plan plus adding calorie replacements are effective dietary intervention
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Adjusting diabetes medications is important for effective long-term weight reduction in patients with diabetes
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Long-term weight reduction is cost-effective for prevention and treatment of diabetes