“It is more important to know what type of person has the disease than to know what type of disease the person has.”
There is strong and consistent evidence that obesity management can delay progression from pre-diabetes to type 2 diabetes and may be beneficial in the treatment of type 2 diabetes. Weight loss should occur early in the natural history of type 2 diabetes when obesity-associated insulin resistance has caused reversible b-cell dysfunction but insulin secretory capacity remains relatively preserved. In overweight and obese patients with type 2 diabetes, modest and sustained weight loss has been shown to improve glycemic control and to reduce the need for glucose-lowering medications; although the feasibility of achieving and maintaining long-term weight loss in these patients is not easy.
Who is my patient? What are their values? What does their daily schedule look like? Do they like to cook? Do they have enough time to do it? What products make their shopping cart? Do they know how to read food labels? Does having or not this information affect their food choice?
Of course, knowing all this information will be crucial because:
- A healthy diet, physical activity and behavioral therapy designed to achieve 5% weight loss should be prescribed for overweight and obese patients with type 2 diabetes.
- There’s not a single ideal dietary distribution of calories among different macronutrients.
- Such interventions should be intense (at least 16 sessions in 6 months) and focus on diet, physical activity, and behavioral strategies to achieve a 500-750 Kcal/day energy deficit.
- For patients who achieve short-term weight loss goals, long term comprehensive weight maintenance programs should be prescribed. High levels of physical activity (200-300 min/week) will be crucial. Digital technologies solutions like the Medtep platform should prove its value as a valid method for collecting patient’s data & patient’s understanding, and can also become an efficient solution to help patients’ recovery and obtain better results.
- An individual nutritional therapy management program is recommended for all patients with type 2 diabetes, although the Action for Health in Diabetes trial (Look AHEAD) didn’t show that an intensive lifestyle intervention reduced cardiovascular events in overweight or obese adults with type 2 diabetes.
- Since diabetes nutrition therapy reduces costs and improve outcomes (e.g. A1C reduction) nutritional management therapy should be adequately reimbursed by insurance companies and other payers.
If we roughly know what to do, but not exactly how to do it, this could be the solution.
Let’s do it as soon as possible, intensely, and enjoying it.
Medtep Chief Medical Officer