This is the current release of the guideline.

• Type 2 diabetes mellitus
• Overweight (body mass index [BMI] 25.0-29.9 kilograms per meter squared [kg/m²])
• Obesity (BMI >30.0 kg/m²)

Management
Prevention

Endocrinology
Family Practice
Internal Medicine
Nutrition
Preventive Medicine

Advanced Practice Nurses
Dietitians
Nurses
Physician Assistants
Physicians

To review the important role of weight management in the prevention and management of type 2 diabetes and to describe strategies for achieving and maintaining a healthy body weight through lifestyle modification

Overweight and obese individuals at risk of or with type 2 diabetes

Weight management through lifestyle modification including:

• Diet
• Physical activity

• Weight loss
• Glycemic control (fasting blood glucose concentrations)
• Use of diabetes medications
• Risk factors for cardiovascular disease (blood pressure, lipid concentrations, serum markers of inflammation)
• Development of type 2 diabetes in high-risk groups

Searches of Electronic Databases

Not stated

Not stated

Not stated

Not applicable

Review
Review of Published Meta-Analyses

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

External Peer Review
Internal Peer Review

American Diabetes Association Statements are reviewed externally and also by the Professional Practice Committee for overall content.

Overweight and obesity are strongly linked to the development of type 2 diabetes and can complicate its management. Obesity is also an independent risk factor for hypertension and dyslipidemia as well as cardiovascular disease, which is the major cause of death in those with diabetes. Moderate weight loss improves glycemic control, reduces cardiovascular disease risk, and can prevent the development of type 2 diabetes in those with pre-diabetes. Therefore, weight loss is an important therapeutic strategy in all overweight or obese persons who have type 2 diabetes or are at risk for developing diabetes.

Specific Recommendations

• Weight loss is recommended for all overweight (body mass index [BMI] 25.0-29.9 kilograms per meter squared [kg/m²]) or obese (BMI >30.0 kg/m²) adults who have, or who are at risk for developing, type 2 diabetes.
• The primary approach for achieving weight loss is therapeutic lifestyle change, which includes a reduction in energy intake and an increase in physical activity.
• A moderate decrease in caloric intake (500-1,000 kilocalories per day [kcal/day]) will result in a slow but progressive weight loss (1-2 pounds per week). For most patients, weight loss diets should supply at least 1,000-1,200 kcal/day for women and 1,200-1,600 kcal/day for men.
• Overweight or obese patients with diabetes are encouraged to adopt the dietary recommendations known to reduce the risk of coronary heart disease (outlined in Tables 3 and 4 of the original guideline document). In conjunction with a moderate reduction in caloric intake (500-1,000 kcal/day), this diet is likely to result in moderate weight loss as well as improvement in cardiovascular risk factors. Dietary guidance should be tailored to each person, allowing for individual food preferences and approaches to reducing caloric intake.
• Physical activity is an important component of a comprehensive weight management program. Regular, moderate-intensity physical activity enhances long-term weight maintenance. Regular activity also improves insulin sensitivity, glycemic control, and selected risk factors for cardiovascular disease (i.e., hypertension and dyslipidemia), and increased aerobic fitness decreases the risk of coronary heart disease.
• Initial physical activity recommendations should be modest, based on the patient's willingness and ability, gradually increasing the duration and frequency to 30 to 45 minutes of moderate aerobic activity, 3 to 5 days per week, when possible. Greater activity levels of at least 1 hour per day of moderate (walking) or 30 minutes per day of vigorous (jogging) activity may be needed to achieve successful long-term weight loss.

None provided

The type of supporting evidence is not specifically stated for each recommendation.

Benefits of Weight Loss

• Moderate weight loss (5% of body weight) can improve insulin action, decrease fasting blood glucose concentrations, and reduce the need for diabetes medications.
• Weight loss has important additional health benefits in patients with diabetes because it improves other risk factors for cardiovascular disease by decreasing blood pressure, improving serum lipid concentrations (decrease in serum triglycerides, total cholesterol, and low-density lipoprotein [LDL] cholesterol and increase in serum high-density lipoprotein [HDL] cholesterol concentrations), and reducing serum markers of inflammation.

Benefits of Physical Activity

Regular exercise and aerobic fitness improve insulin sensitivity and glycemic control, may decrease the risk of developing diabetes, and may reduce overall mortality in patients who have type 2 diabetes.

Not stated

Although many different dietary approaches may result in short-term weight loss, the limitation of most diets is poor long-term compliance and weight regain. The optimal dietary macronutrient composition that facilitates lasting and safe weight loss is not known.

An implementation strategy was not provided.

Living with Illness
Staying Healthy

Effectiveness
Patient-centeredness

Not applicable: The guideline was not adapted from another source.

2004 Aug

American Diabetes Association - Professional Association
American Society for Clinical Nutrition - Professional Association
North American Association for the Study of Obesity - Professional Association

American Diabetes Association (ADA)

Not stated

Primary Authors: Samuel Klein, MD, Division of Geriatrics and Nutritional Sciences and Center for Human Nutrition, Washington University School of Medicine, St. Louis, Missouri; Nancy F. Sheard, SCD, RD, Department of Family Practice, University of Vermont, Burlington, Vermont; Xavier Pi-Sunyer, MD, MPH, Division of Endocrinology, Diabetes and Nutrition, St. Luke's—Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, New York New York; Anne Daly, MS, RD, BC-ADM, CDE, Springfield Diabetes & Endocrine Center, Springfield, Illinois; Judith Wylie-Rosett, EDD, RD, Division of Health, Behavior and Nutrition, Albert Einstein College of Medicine, Bronx, New York; Karmeen Kulkarni, MS, RD, BC-ADM, CDE, St Mark's Diabetes Center, Salt Lake City, Utah; Nathaniel G. Clark, MD, MS, RD, American Diabetes Association, Alexandria, Virginia

Samuel Klein, MD is a member of the Obesity and Diabetes Educational Council, which is funded by an unrestricted educational grant provided by Roche Laboratories, is on the Enteromedics Medical Advisory Board, has received honoraria from Merck, and has received research support from Transneuronix.

Judith Wylie-Rosett, EDD, RD has received research funding from the Dr. Robert C. Atkins Foundation.

This is the current release of the guideline.

None available

None available

This NGC summary was completed by ECRI on April 18, 2005.