diabesity manchester march 2014
DESCRIPTION
Obesity and Related Conditions 25 March ManchesterTRANSCRIPT
Action on Diabesity
Dr C Rajeswaran
Consultant Physician ( Diabetes, Obesity & Endocrinology)
Chair, National Diabesity Forum
Director, simplyweight Ltd
Diabesity - 21st century pandemic
Diabesity is now the single greatest contributor to chronic disease
Diabesity describes the twin epidemic of obesity and diabetes that we are facing throughout the world.
Imagine having "diabesity" and being addicted to
alcohol, caffeine nicotine......................“Alconicocafdiabesity?"
Multi hormone control of body weight:
Fat,gut and islets derived signals
Obesity and overweight .. conditions in which body fat has accumulated to such an extent that health may be adversely affected (WHO, 2000)
Adjusted odds ratio for death, by metabolic category for 51-61years age group
Diabetes 2.63
Obesity 0.78
Obesity and diabetes 6.81
Oldridge et al, Jr of clinical Epidemiology 54(2001);928-934
Weight gain in patients with type 2 diabetes can contribute to patient frustration and may negatively impact their compliance to therapeutic regimens.
F. Xavier Pi-Sunyer, Postgraduate Medicine: Volume 121: No.5The Impact of Weight Gain on Motivation, Compliance, and Metabolic Control in Patients with Type 2 Diabetes Mellitus
Glycaemic control and body weight
Weight gain appears unavoidable when patients with Type 2 diabetes are commenced on insulin
Body weight increases by 2Kg for each percentage point decrease in HbA1C during the first year1
.
1.Makimattila et al Diabetologia 1999;42;406-412
Diabesity-Management?
Potential benefits of 10kg weightloss in individuals of 100kg
Diabesity Team
Endocrinologist
Diabesity Nurse specialist
Dietitian
Physiotherapist
occupational therapists
Social worker
Psychologists
Bariatric surgeon
Evaluation:
Detailed History
Perception
Motivation
Hunger pattern
Body image
Glycaemic excursion
Evaluation:Psychological state
Anthropometry
Problems with ADL (activities of daily living)
Mobility
Sleep study
Endocrine abnormality
Evaluation:In addition to evaluating complications of diabetes, Obesity related complications are assessed
WHY ARE YOU EATING SO FAST?
I WANT TO EAT AS MUCH AS POSSIBLE
BEFORE I LOSE MY APPETITE!!
Brain Reward System
Control of appetite
Genes and Weight
Genes
Environment
40%60%
Drug Class May cause Weight gain Less weight gain, weight loss or weight neutral
Antipsychotics ClozapineRisperidoneOlanzipine
ZiprasidoneAripiprazole
Antidepressants and Mood stabilizers
CitalopramLithiumMAOIsTCAsVenlafaxineMirtazapineParoxetine
BupropionSertralineFluoxetine
Anticonvulsants CarbamazepineGabapentinValproate
LamotrigineTopiramate
Diabetes Drugs InsulinSulphonylureasThiazolidinediones
MetforminAcarboseGLP-1DDPIV
Antihypertensives Alpa blockersBeta blockers
ACE inhibitorsCalcium Channel Blockers
Oral Contraceptives Progesterone only pillCombination pill with progesterone
Barrier methodIUDs
Understanding Hunger Pattern
NEAT: Non exercise activity thermogenesis
Dieting cause weight gain
Surgery Effective Early Intervention for
Diabesity
Gastric balloon
http://www.healthierweight.co.uk/obesity-surgery/gastric-band/what-is-a-gastric-band/how-does-the-band-work/
Gastric Banding
SA 46 years male
Type 2 Diabetes (2002)
Morbid Obesity
Metformin 2.5 gms
Insulin 180 units
Examination:
Weight 164Kg (25.82 Stones)
Rest of examination unremarkable
Child hood……..
Puberty………
Family………
Social history……..
Personal history……..
H/O weight loss management & medical history
Investigations:
No evidence of Obstructive sleep apnoea
HbA1c-11.2%
Testosterone 6 nmol/l
SHBG 26
LH 2.1
FSH 1.3
Management
Testosterone 5gm gel OD
Calorie restriction
Clinic follow up
Weight 148 Kg (Initial wt 164)
NOT tired, No day time sleepiness
Insulin160 units a day
HbA1c 10.2%
Exenatide introduced
And
Insulin gradually weaned off
Under very close supervision
Clinic( 6 months)
119Kg (Initial wt -164Kg)
HbA1c - 8%
•Not every option is appropriate for every individual.
•Holistic approach is the key in a DIABESITY Clinic
Glycaemic control
Body weight and hunger pattern
Psychological issues
Underlying endocrine abnormalities
“ Of course doughnuts are good for you.
They’re HOLE grain!”
Thank you!