From the Guidelines
Weight loss in uncontrolled diabetes is a serious condition that requires immediate attention to prevent long-term complications, and the most effective approach to managing it is through a combination of medication, diet, and exercise, with a focus on controlling blood sugar levels and improving insulin sensitivity, as recommended by the 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases 1.
Causes of Weight Loss
Weight loss in uncontrolled diabetes occurs because the body cannot properly use glucose for energy. When blood sugar levels are high, glucose cannot enter cells due to insulin deficiency or resistance, forcing the body to break down fat and muscle for energy instead. This process leads to significant weight loss despite normal or increased food intake. The weight loss is often accompanied by increased thirst, frequent urination, and constant hunger.
Treatment Approach
To address this, treatment focuses on controlling blood sugar through medication, diet, and exercise. For type 1 diabetes, insulin therapy is essential. For type 2 diabetes, medications like metformin (starting at 500mg once or twice daily, gradually increasing to 1000mg twice daily as tolerated) help improve insulin sensitivity, as noted in the study on the practical use of pharmacotherapy for obesity 1. Lifestyle changes including a balanced diet, regular physical activity, and monitoring blood glucose levels are crucial parts of management.
Lifestyle Modifications
The 2019 ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases recommend lifestyle changes as key to preventing diabetes and its cardiovascular complications, including reduced calorie intake to lower excessive body weight in patients with diabetes, a Mediterranean diet supplemented with olive oil and/or nuts to reduce the incidence of major cardiovascular events, and moderate-to-vigorous physical activity of >150 min/week for the prevention and control of diabetes 1. Even modest weight loss delays progression from pre-diabetes to type 2 diabetes, with each additional kilogram loss associated with 43% lower odds of type 2 diabetes, as shown in a recent meta-analysis 1.
Outcome
Once diabetes is properly controlled with appropriate medication and lifestyle modifications, the unhealthy weight loss typically stops, and patients often regain appropriate weight as their body begins to properly utilize glucose again. Maintenance of weight loss for 5 years is recommended, with benefits including improved glycemic control, lipid levels, and blood pressure, as well as reduced risk of cardiovascular events, as demonstrated by the Action for Health in Diabetes (Look AHEAD) trial and the Diabetes Remission Clinical Trial (DiRECT) 1.
From the Research
Weight Loss from Uncontrolled Diabetes
- Weight loss in patients with type 2 diabetes can be achieved through a combination of low-carbohydrate diet, exercise, and adjustment of medications, as seen in a case study where a patient lost 10% of their initial body weight in approximately 36 weeks 2.
- Medications that can exacerbate weight gain, such as insulin glargine and glyburide, can be discontinued and replaced with medications that promote weight loss, such as metformin, liraglutide, and canagliflozin 2.
- Metformin has been shown to be more effective in promoting weight loss in patients with type 2 diabetes compared to thiazolidinediones (TZDs), although TZDs may decrease visceral fat levels 3.
- Weight management in type 2 diabetes is crucial, as obesity increases the risk of diabetes and contributes to disease progression and cardiovascular disease, and weight reduction remains challenging for individuals with type 2 diabetes due to metabolic and psychological factors 4.
- Pharmacological strategies, such as metformin and TZDs, can support glycemic and weight-loss goals in individuals with type 2 diabetes, and combination therapies may be effective in managing obese patients with type 2 diabetes 4, 5.
- Lifestyle interventions, such as diet and exercise, can be effective for weight loss and improving diabetes control, but may have limited effectiveness for achieving diabetes remission, and medical approaches like bariatric surgery may be necessary for greater magnitudes of weight loss 6.