Weight gain during insulin therapy in patients with type 2 diabetes mellitus
Section snippets
The problem: intensive insulin therapy leads to weight gain
The benefits of averting hyperglycemia in patients with diabetes mellitus are unequivocal, as shown by worldwide studies comparing conventional therapy with more intensive therapy (defined by maintaining glycated hemoglobin A1c targets at 7.0% or lower). Findings from the UK Prospective Diabetes Study (UKPDS) Group showed that intensive therapy with insulin or sulfonylurea drugs in patients with type 2 diabetes significantly reduced the risk of microvascular complications, especially
Changes in serum lipids and body fat—what are the consequences?
Neither the UKPDS nor the DCCT yielded significant macrovascular benefits from intensive diabetes therapy [1], [3]. Potential benefits of glycemic control may be offset by problems caused by weight gain. It is therefore important to define the risk-benefit relationship of weight gain and intensive insulin therapy and to determine the most effective ways to limit weight gain.
The DCCT results suggested a trend towards a reduction in macrovascular events with intensive therapy when cardiovascular
What are the mechanisms of treatment-associated weight gain?
A number of mechanisms have been suggested to explain how insulin is responsible for weight gain and include the anabolic effects of high-dose insulin, appetite increase and increased freedom to eat without risk of hyperglycemia, and the reduction of glycosuria with resultant retention of calories (Table 1).
Insulin has long been recognized to have anabolic effects on both muscle and fat [10], [11]. It is therefore consistent that insulin therapy would cause weight gain. Notably, 14 individuals
Strategies to limit weight gain or promote weight loss
Various strategies have been proposed for weight control in people with diabetes, and sometimes more than one approach is needed. These include selecting a therapeutic regimen that limits weight gain, and educating the patient about lifestyle changes that help to achieve and maintain a healthy body weight. Weight-loss medications can also help certain patients, and bariatric surgery has proven successful for patients who are morbidly obese.
Conclusions
In individuals with type 2 diabetes, weight gain during treatment with insulin and other agents prevents the attainment of glycemic targets and probably limits the success of treatment. Insulin-related weight gain has been variously attributed to the anabolic effects of high-dose insulin, appetite increases, and reduction of glycosuria with a resultant retention of calories.
Multiple strategies can be used for weight control in patients with type 2 diabetes, but many current approaches have
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