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Year : 2022  |  Volume : 1  |  Issue : 2  |  Page : 88-98

Choice of therapy in obese type 2 diabetes

1 Department of Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, New Delhi, India
2 Department of Diabetes and Endocrinology, Chellaram Diabetes Institute, Pune, Maharashtra, India

Correspondence Address:
Viveka P Jyotsna
Department of Endocrinology, Metabolism and Diabetes, All India Institute of Medical Sciences, New Delhi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/cdrp.cdrp_2_22

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Obesity is a chronic metabolic disease affecting individuals all over the world and is known to be a main risk factor for type 2 diabetes (T2D). In countries like India, T2D occurs with a lower degree of obesity as compared to T2D in western countries. It is important to tackle obesity in T2D because studies have shown that modest weight loss leads to improvements in glycemic levels, thereby reducing the risk of diabetes-related complications and comorbidities. Obesity complicates the management of diabetes, particularly the goal of achieving tight glycemic control as it is associated with insulin resistance. In this article, we are going to discuss choice of therapies in the management of T2D in obese individuals. In patients with T2D and obesity treatment approach should be individualized and it includes intensive lifestyle intervention, pharmacologic therapy, and/or metabolic surgery. Additional attention should be given to concomitant therapies for other comorbidities which may further lead to weight gain. Considering the strong link between obesity and T2D, the first choice of therapy after lifestyle modification should be glucose-lowering agents, which promote weight reduction or are at least weight neutral. Metformin, alpha-glucosidase inhibitor, sodium-glucose co-transporter 2 (SGLT-2) inhibitor, glucagon-like peptide–1 receptor agonist (GLP-1 RA), and amylin mimetic promote weight loss along with additional cardiovascular benefits of GLP-1 RA, SGLT-2 inhibitor, and improved renal outcomes with SGLT-2 inhibitor. Weight neutral therapies include dipeptidyl peptidase-4 inhibitors and fixed ratio insulin/GLP-1 RA combination therapies (insulin degludec/liraglutide, insulin glargine and lixisenatide) can also be considered as they help to limit weight gain. Therapies such as thiazolidinedione, insulin secretagogue (sulfonylurea and meglitinide), and insulin are less suitable for individuals with obesity and T2D as they are associated with weight gain.

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