Fig. 17.

“Treat obesity first” prioritization for patients with obesity and type 2 diabetes mellitus (T2DM) without acute disease. Treatment of obesity is the priority for most patients without acute illness, especially if the therapies chosen for treatment of the obesity are also expected to improve the complications of obesity. Conversely, patients with marked increases in glucose and/or blood pressure, severe dyslipidemia (e.g., severe hypertriglyceridemia), acute thrombosis, cardiovascular disease (CVD), or cancer should have these acute metabolic abnormalities urgently assessed, managed, and treated – preferably with concomitant interventions that may also improve obesity. For example, while glucagon-like peptide-1 receptor agonist based therapies may reduce body weight and improve glycemic control in patients with overweight/obesity [20], if the patient with obesity and T2DM has heart failure, then beyond their indicated use as anti-diabetes medications, some sodium glucose transporter 2 inhibitors (SGLT1i) have clinical outcome data to support improvement in both CVD and heart failure [178], and may also facilitate mild weight reduction [179,180].