Insulin treatment and the problem of weight gain in type 2 diabetes.
OBJECTIVE
Insulin therapy has been shown to benefit the prognosis in patients with type 2 diabetes, but its initiation and intensification is often delayed through concerns about hypoglycemia and weight gain. In addition, weight gain is linked to the pathophysiology of type 2 diabetes and contributes to the overall risk for adverse cardiovascular outcomes. This article attempts to summarize this issue and examine the options available for weight management.


METHODS
A broad range of literature has been reviewed to distill important, consistent facts about insulin and weight gain and the options available for limiting the problem.


RESULTS
Unfortunately, the great benefits of insulin therapy may be potentially undermined by weight gain. Weight gain is physiologically and psychologically undesirable, especially in patients with diabetes who are already overweight. The fear of weight gain with some medications contributes to psychological insulin resistance, which may discourage patients from commencing or following insulin regimens. However, new diabetes treatments and lifestyle interventions can be used to mitigate these problems.


CONCLUSIONS
The exact choice of insulin and oral medications and weight loss interventions are important considerations in the overall management of patients with type 2 diabetes. Changes in a patient's lifestyle, such as modifications to diet and implementing an exercise program, are first-line treatments for type 2 diabetes and can also counteract insulin-induced weight gain.
Carver
Catherine
C
Joslin Diabetes Center, One Joslin Place, Boston, MA 02215, USA. cathy.carver@joslin.harvard.edu
D000284:Administration, Oral; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology*; D003927:Diet, Diabetic; D015444:Exercise; D006029:Glycosuria; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use*; D008019:Life Style; D009765:Obesity / Q000453:epidemiology*; D015430:Weight Gain
D007004:Hypoglycemic Agents; D007328:Insulin