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Long-term benefits of insulin therapy and glycemic control in overweight and obese adults with type 2 diabetes.
J Diabetes Complications 2009 Mar-Apr; 23(2):143-52JD

Abstract

PROBLEM

Obesity and type 2 diabetes have reached epidemic proportions in the United States. Obese patients are at especially high risk for the development of metabolic syndrome, a clustering of metabolic abnormalities associated with insulin resistance that usually precede the development of cardiovascular disease. Overweight or obesity, along with insulin resistance, is frequently present in people with type 2 diabetes.

METHODS

A literature search of the PubMed and MEDLINE databases, using the terms diabetes, obesity, metabolic syndrome, glycemic control, antidiabetic therapy, and insulin, was performed. Articles published between 1985 and 2006 that examined diabetes management in the obese population were selected and reviewed.

RESULTS

There is new evidence suggesting that tight glycemic control and earlier initiation of insulin therapy can improve outcomes in obese patients with type 2 diabetes, thereby reducing the risk for the development of both macrovascular and microvascular complications of the disease. Insulin also appears to exhibit anti-inflammatory effects, which may provide additional protection against the development of atherosclerosis. Despite the benefits of insulin therapy, many patients and physicians remain reluctant to start insulin due to concerns about weight gain.

CONCLUSION

Newer insulin formulations can effectively improve glycemic control without significant effects on patient weight and, therefore, may be particularly useful in patients who are overweight or obese. Implementation of comprehensive treatment regimens that emphasize dietary modification, physical activity, and exercise, and aggressive use of pharmacological agents to achieve tight glycemic control through physiological regimens offer the most promise for reducing long-term complications in obese patients with type 2 diabetes.

Authors+Show Affiliations

Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA. enrique.caballero@joslin.harvard.edu

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

18413192

Citation

Caballero, A Enrique. "Long-term Benefits of Insulin Therapy and Glycemic Control in Overweight and Obese Adults With Type 2 Diabetes." Journal of Diabetes and Its Complications, vol. 23, no. 2, 2009, pp. 143-52.
Caballero AE. Long-term benefits of insulin therapy and glycemic control in overweight and obese adults with type 2 diabetes. J Diabetes Complicat. 2009;23(2):143-52.
Caballero, A. E. (2009). Long-term benefits of insulin therapy and glycemic control in overweight and obese adults with type 2 diabetes. Journal of Diabetes and Its Complications, 23(2), pp. 143-52. doi:10.1016/j.jdiacomp.2007.06.002.
Caballero AE. Long-term Benefits of Insulin Therapy and Glycemic Control in Overweight and Obese Adults With Type 2 Diabetes. J Diabetes Complicat. 2009;23(2):143-52. PubMed PMID: 18413192.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term benefits of insulin therapy and glycemic control in overweight and obese adults with type 2 diabetes. A1 - Caballero,A Enrique, Y1 - 2008/04/16/ PY - 2007/03/06/received PY - 2007/05/25/revised PY - 2007/06/01/accepted PY - 2008/4/17/pubmed PY - 2009/5/16/medline PY - 2008/4/17/entrez SP - 143 EP - 52 JF - Journal of diabetes and its complications JO - J. Diabetes Complicat. VL - 23 IS - 2 N2 - PROBLEM: Obesity and type 2 diabetes have reached epidemic proportions in the United States. Obese patients are at especially high risk for the development of metabolic syndrome, a clustering of metabolic abnormalities associated with insulin resistance that usually precede the development of cardiovascular disease. Overweight or obesity, along with insulin resistance, is frequently present in people with type 2 diabetes. METHODS: A literature search of the PubMed and MEDLINE databases, using the terms diabetes, obesity, metabolic syndrome, glycemic control, antidiabetic therapy, and insulin, was performed. Articles published between 1985 and 2006 that examined diabetes management in the obese population were selected and reviewed. RESULTS: There is new evidence suggesting that tight glycemic control and earlier initiation of insulin therapy can improve outcomes in obese patients with type 2 diabetes, thereby reducing the risk for the development of both macrovascular and microvascular complications of the disease. Insulin also appears to exhibit anti-inflammatory effects, which may provide additional protection against the development of atherosclerosis. Despite the benefits of insulin therapy, many patients and physicians remain reluctant to start insulin due to concerns about weight gain. CONCLUSION: Newer insulin formulations can effectively improve glycemic control without significant effects on patient weight and, therefore, may be particularly useful in patients who are overweight or obese. Implementation of comprehensive treatment regimens that emphasize dietary modification, physical activity, and exercise, and aggressive use of pharmacological agents to achieve tight glycemic control through physiological regimens offer the most promise for reducing long-term complications in obese patients with type 2 diabetes. SN - 1873-460X UR - https://www.unboundmedicine.com/medline/citation/18413192/Long_term_benefits_of_insulin_therapy_and_glycemic_control_in_overweight_and_obese_adults_with_type_2_diabetes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1056-8727(07)00067-0 DB - PRIME DP - Unbound Medicine ER -