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Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-2166-6797
German Diabetes Associaton: Clinical Practice Guidelines

Obesity and Diabetes

Jens Aberle
1   Section Endocrinology and Diabetology, University Obesity Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
Anne Lautenbach
1   Section Endocrinology and Diabetology, University Obesity Centre, University Hospital Hamburg-Eppendorf, Hamburg, Germany
,
Svenja Meyhöfer
2   Institute for Endocrinology & Diabetes, University of Lübeck, Department of Internal Medicine 1, Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
,
Sebastian M. Meyhöfer
2   Institute for Endocrinology & Diabetes, University of Lübeck, Department of Internal Medicine 1, Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
,
Markus Menzen
3   Department of Internal Medicine, Diabetes Centre, Gemeinschaftskrankenhaus Bonn, Bonn, Germany
,
Lars Selig
4   Nutrition Team/Nutrition Outpatient Clinic, University Hospital – AoR Leipzig, Leipzig, Germany
,
Knut Mai
5   Department of Endocrinology and Metabolic Medicine (incl. Department of Lipid Metabolism), Charité Universitätsmedizin Berlin, Berlin, Germany
,
Matthias Blüher
6   Department of Internal Medicine III – Endocrinology, Nephrology, Rheumatology, University of Leipzig, Leipzig, Germany
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NOTICE OF UPDATE

The DDG clinical practice guidelines are updated regularly during the second half of the calendar year. Please ensure that you read and cite the respective current version.

UPDATES TO CONTENT COMPARED TO THE PREVIOUS YEAR’S VERSION

Change 1: Update of the GLP-1 receptor agonists section

Reason: Approval of semaglutide 2.4 mg 1×weekly by the EU Commission in the indication of obesity

Supporting reference: [20]

Change 2: Update of incretin coagonists section

Reason: Publication of SURPASS-2 and SURMOUNT-1 data

Supporting reference: [22] [24]

The effectiveness of weight reduction in the treatment and prevention of type 2 diabetes has been proven by many studies. The effectiveness of weight reduction in the treatment and prevention of type 2 diabetes has been proven by many studies. In the “Finnish Diabetes Prevention Study”, the conversion of prediabetes to type 2 diabetes was reduced by 58% through lifestyle intervention [1]. Similar results were obtained in the “Diabetes Prevention Program” [2]. An English study showed that for every 1 kg of weight lost in the first year after diagnosis of type 2 diabetes, life expectancy increases by 3−4 months [3], and Williamson et al. [4] showed that a weight reduction of 10 kg reduces overall mortality in people with type 2 diabetes by 25%. In addition, weight reduction not only improves blood glucose levels, but also virtually all comorbidities of diabetes simultaneously (hypertension, fatty liver disease, depression, obstructive sleep apnoea syndrome (OSAS), etc.). However, these effects appear to be particularly strong when a weight reduction of at least 5% can be achieved [5]. Weight gain in type 2 diabetes treatment worsens cardiovascular risk factors and is associated with an increase in cardiovascular events and mortality [6].

The 2022 consensus report of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) [7] defines a weight reduction of at least 5–15% as a treatment goal for most people with type 2 diabetes, with a 10–15% decrease even leading to diabetes remission [8]. As a general treatment goal, patients with obesity and diabetes should aim for weight stabilization in the range of the normal weight (body mass index [BMI] 18.5–24.9 kg/m2). The waist circumference of women and men should be ≤ 80 cm and ≤ 94 cm respectively [8] [9] ([Fig. 1]).

Zoom Image
Fig. 1 Equivalent therapeutic goals in the treatment of type 2 diabetes.

The achievement of standard-compliant HbA1c and weight values is therefore a consistent therapeutic goal of current guidelines, which should be used as a guide for blood glucose-lowering and other drug therapies of type 2 diabetes.



Publication History

Article published online:
07 March 2024

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  • References

  • 1 Lindström J, Louheranta A, Mannelin M. et al. The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 2003; 26: 3230-3236
    Google Scholar
  • 2 Knowler WC, Barrett-Connor E, Fowler SE. et al. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med 2002; 346: 393-403
    Google Scholar
  • 3 Lean MEJ, Powrie JK, Anderson AS. et al. Obesity, Weight Loss and Prognosis in Type 2 Diabetes. Diabet Med 1990; 7: 228-233
    Google Scholar
  • 4 Williamson DF, Thompson TJ, Thun M. et al. Intentional weight loss and mortality among overweight individuals with diabetes. Diabetes Care 2000; 23: 1499-1504
    Google Scholar
  • 5 Wing RR, Bahnson JL, Bray GA. et al. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: Four-year results of the look AHEAD trial. Arch Intern Med 2010; 170: 1566-1575
    Google Scholar
  • 6 Eeg-Olofsson K, Cederholm J, Nilsson PM. et al. Risk of cardiovascular disease and mortality in overweight and obese patients with type 2 diabetes: An observational study in 13,087 patients. Diabetologia 2009; 52: 65-73
    Google Scholar
  • 7 Davies M, Aroda VR, Collins BS. et al. Management of Hyperglycemia in Type 2 Diabetes, 2022. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2022; 45: 2753-2786
    Google Scholar
  • 8 Wang Z, Hoy WE. Waist circumference, body mass index, hip circumference and waist-to-hip ratio as predictors of cardiovascular disease in Aboriginal people. Eur J Clin Nutr 2004; 58: 888-893
    Google Scholar
  • 9 Pischon T, Boeing H, Hoffmann K. et al. General and abdominal adiposity and risk of death in Europe. N Engl J Med 2008; 359: 2105-2120
    Google Scholar
  • 10 Evert AB, Dennison M, Gardner CD. et al. Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Diabetes Care 2019; 42: 731-754
    Google Scholar
  • 11 Churuangsuk C, Hall J, Reynolds A. et al. Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission. Diabetologia 2022; 65: 14-36
    Google Scholar
  • 12 Hansen TT, Astrup A, Sjödin AL. et al. Are Dietary Proteins the Key to Successful Body Weight Management? A Systematic Review and Meta-Analysis of Studies Assessing Body Weight Outcomes after Interventions with Increased Dietary Protein. Nutrients 2021; 13: 3193
    Google Scholar
  • 13 Lean ME, Leslie WS, Barnes AC. et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, clusterrandomised trial. Lancet 2018; 391: 541-551
    Google Scholar
  • 14 Gregg EW, Chen H, Wagenknecht LE. et al. Association of an intensive lifestyle intervention with remission of type 2 diabetes. JAMA 2012; 308: 2489-2496
    Google Scholar
  • 15 Nationale VersorgungsLeitlinie (NVL) Typ-2-Diabetes. 1. Aufl
  • 16 Kay SJ, Fiatarone Singh MA. The influence of physical activity on abdominal fat: A systematic review of the literature. Obes Rev 2006; 7: 183-200
    Google Scholar
  • 17 ElSayed NA, Aleppo G, Aroda VR. et al. on behalf of the American Diabetes Association Diabetes Care. Obesity and Weight Management for the Prevention and Treatment of Type 2 Diabetes: Standards of Care in Diabetes – 2023. Diabetes Care 2023; 46: S128-S139
    Google Scholar
  • 18 Vilsbøll T, Christensen M, Junker AE. et al. Effects of glucagon-like peptide-1 receptor agonists on weight loss: Systematic review and metaanalyses of randomised controlled trials. BMJ 2012; 344: d7771
    Google Scholar
  • 19 Pi-Sunyer X, Astrup A, Fujioka K. et al. A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. N Engl J Med 2015; 373: 11-22
    Google Scholar
  • 20 Wilding JPH, Batterham RL, Calanna S. et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med 2021; 384: 989-1002
    Google Scholar
  • 21 Rubino DM, Greenway FL, Khalid U. et al. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial. JAMA 2022; 327: 138-150
    Google Scholar
  • 22 Rosenstock J, Wysham C, Frías JP. et al. Efficacy and safety of a novel dual GIP and GLP-1 receptor agonist tirzepatide in patients with type 2 diabetes (SURPASS-1): a double-blind, randomised, phase 3 trial. Lancet 2021; 398: 143-155
    Google Scholar
  • 23 Frías JP, Davies MJ, Rosenstock J. et al. Tirzepatide versus Semaglutide Once Weekly in Patients with Type 2 Diabetes. N Engl J Med 2021; 385: 503-515
    Google Scholar
  • 24 Jastreboff AM, Aronne LJ, Ahmad NN. et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med 2022; 387: 205-216
    Google Scholar
  • 25 Garvey WT, Frias JP, Jastreboff AM. et al. Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): a double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 2023; 402: 613-626
    Google Scholar
  • 26 Rubino F, Nathan DM, Eckel RH. et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: A joint statement by international diabetes organizations. Diabetes Care 2016; 39: 861-877
    Google Scholar
  • 27 S3-Leitlinie: Chirurgie der Adipositas und metabolischer Erkrankungen. Version 2.3 (Februar 2018).
  • 28 Flum DR, Belle SH, King WC. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium et al. Perioperative Safety in the Longitudinal Assessment of Bariatric Surgery. N Engl J Med 2009; 361: 445-454
    Google Scholar
  • 29 Birkmeyer NJO, Dimick JB, Share D. et al. Hospital complication rates with bariatric surgery in Michigan. JAMA 2010; 304: 435-442
    Google Scholar
  • 30 Aberle J, Reining F, Dannheim V. et al. Metformin after bariatric surgery – An acid problem. Exp Clin Endocrinol Diabetes 2012; 120: 152-153
    Google Scholar