الفهرس | Only 14 pages are availabe for public view |
Abstract Even modest weight loss appears to benefit overweight/obese patients with type 1 diabetes, whereas weight gain is thought to blunt the beneficial metabolic effects of antidiabetic agents and insulin treatment. Therefore, most diabetic patients should be encouraged to initiate and maintain lifestyle changes, including improvements in diet and exercise, to help them lose weight and achieve glycaemic and non-glycaemic targets, thus reducing the risk of chronic diabetic complications. The use of antidiabetic agents that are neutral on body weight (e.g., DPP–4 inhibitors) or promote weight loss (e.g., metformin, GLP–1 mimetics or rimonabant) may be preferred. The current ADA/EASD guidelines recommend lifestyle intervention and metformin as initial treatment in type 2 diabetes and stress the need to rapidly add other agents or change regimens when glycaemic goals are not being met and maintained . In overweight/ obese patients, incretin-based therapies with GLP-1 mimetics and DPP-4 inhibitors appear to be a particularly useful option in patients who do not reach glycaemic goals on metformin or in whom metformin cannot be used.When compared with GLP-1 mimetics, the DPP-4 inhibitors are neutral on body weight, but can be taken orally and have fewer adverse effects. |