tailieunhanh - Diagnosis and Management of Pituitary Disorders - part 8

Tỷ lệ béo phì bắt đầu tăng năm 1980, và một phần ba dân số Hoa Kỳ bây giờ là béo phì. Những rủi ro y tế của bệnh béo phì có liên quan đến đề kháng insulin và bệnh tiểu đường phổ biến sau đó của bệnh béo phì bởi một thập kỷ. C | 20 Obesity and Its Treatment in Type 2 Diabetes Frank L. Greenway and William T. Cefalu Contents Introduction Pharmacologic and Surgical Treatment Behavior Modification and LiFESTyLE Change Pharmacologic Treatment Diabetes Medications ŨBESity SURGERy Conclusions References Summary The prevalence of obesity began rising about 1980 and one third of the US population is now obese. The medical risks of obesity are linked to insulin resistance and diabetes prevalence follows that of obesity by a decade. This chapter approaches the treatment of obesity in the context of diabetes. The role of behavior modification meal replacements and commercial weight loss programs are discussed. Medications that were approved before 1986 are approved for short-term use and are chemically related to amphetamine. Obesity medications approved after 1986 and are approved for long-term use and include a lipase inhibitor and an inhibitor of norepinephrine and serotonin reuptake. All these drugs give modest weight losses of less than 5kg in excess of placebo. Rimonabant a cannabanoid-1 receptor antagonist received an approvable letter from the FDA for the treatment of obesity but its new drug application was ultimately rejected. Metformin and acarbose are 2 oral diabetes medications that give some degree of weight loss as do the injectable diabetes medications pramlintide and exenatide. Thiazoladinediones sulfonylureas and insulin give weigh gain whereas the meglitinides and the DPP-4 inhibitors are weight neutral. Restrictive surgical procedures like the lap-band are one type of obesity surgery and restrictive-malabsorptive procedures like gastric bypass is the other. Weight loss is more durable and the improvement in diabetes is more dramatic with the restrictive-malabsorptive procedures. Lifestyle change is the basis for all obesity treatments. Obesity medications and surgical procedures are useful adjuncts and all obesity treatments are best delivered by a team as is the case with .