The management of the obese diabetic patient

Lifestyle modifications with diet and exercise are an essential part of the management of the obese diabetic patient. These measures alone are often insufficient; concomitant pharmacologic therapy is usually required to achieve glycemic and weight control. When insulin therapy is required, combinations with oral agents, which have been shown to minimize the amount of exogenous insulin that is required, may minimize weight gain. In addition, the obese diabetic patient who does not respond well to maximum oral hypoglycemic therapy may benefit from weight-reducing agents, such as sibutramine or orlistat. For the severely obese diabetic patient, bariatric surgery may be the only effective treatment. Gastric bypass has been unequivocally shown to produce significant weight loss and improve glycemic control on a long-term basis. It is recommended that physicians avail themselves of all of these strategies in the management of the obese patient who has type 2 diabetes.