Table 1.

Ten things to know about how type 2 diabetes mellitus impairs weight reduction among patients with increased adiposity.

1.The presence of type 2 diabetes mellitus impairs weight reduction among patients with obesity treated with healthful nutrition, physical activity, behavior modification, and medical treatment (i.e., anti-obesity medications and bariatric surgery).

2.When weight reduction improves glucose control in patients with diabetes mellitus, then energy is conserved due to reduced glucosuria.

3.Especially early in the onset of type 2 diabetes mellitus, insulin resistance results in hyperinsulinemia. Insulin stimulates lipid uptake and storage in adipocytes and inhibits lipolysis, which are obesogenic mechanisms not found in patients who do not have insulin resistance.

4.Many patients with type 2 diabetes mellitus are treated with obesogenic medications (e.g., insulin, sulfonylureas, meglitinides, and thiazolidinediones). Additionally, administration of the first three listed hypoglycemic medications (i.e., anti-diabetes mellitus medications that increase insulin exposure) may contribute to hypoglycemia, necessitating increased caloric intake to avoid or treat low blood sugar. Increasing caloric consumption to treat or avoid hypoglycemia may impair weight reduction compared to patients without diabetes mellitus who do not require increased caloric consumption to treat or avoid hypoglycemia.

5.Body system abnormalities that may contribute to impaired weight reduction in patients with type 2 diabetes mellitus include endocrine, musculoskeletal, neurological, cardiovasculo-pulmonary, immune, ophthalmologic, nephrologic, dermatologic, and gastrointestinal.

6.Patients with type 2 diabetes mellitus are often older than patients without type 2 diabetes mellitus. Increasing age impairs weight reduction.

7.Patients with type 2 diabetes mellitus may have sex and genetic/epigenetic predisposition to obesity, which may impair weight reduction.

8.Obesogenic mechanisms that may contribute to impaired weight reduction among patients with type 2 diabetes mellitus include established meal planning, socioeconomic factors, psychosocial factors, bias, and discrimination.

9.Irrespective of the weight reduction challenges with the presence of type 2 diabetes mellitus, each of the four pillars of obesity management [healthful nutrition, physical activity, behavior modification, and medical therapy (i.e., anti-obesity medications and bariatric surgery)] can achieve clinically meaningful weight reduction among many patients with type 2 diabetes mellitus, potentially promoting remission of type 2 diabetes mellitus.

10.Pharmacologic treatment of type 2 diabetes mellitus should prioritize use of anti-diabetes medications that increase insulin sensitivity, reduce insulin levels, and reduce body weight (e.g., metformin, glucagon-like peptide-1 based therapies, sodium glucose- cotransporter 2 inhibitors), and deprioritize use of anti-diabetes medications that increase insulin exposure and increase body weight (e.g., sulfonylureas, insulin, meglitinides).