The Obesity/Diabetes Epidemic: Adiposopathy

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The Obesity/Diabetes EpidemicAdiposopathy
Obesity- The New Disease!Weight Management in
Obesity and DM Emphasis on  New Medical Therapies
Part 9

• Stan Schwartz MD, FACP, FACE
• Private Practice, Ardmore
• Obesity Program
• Cardiometabolic Diabetes Center and Affiliate,
• Main Line Health System
• Emeritus, Clinical Associate Professor
• University of Pennsylvania

Part 9 of 9
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• Weight Reduction Issues- Non -Insulin

0. In Metabolic Syndrome-consider Incretins/
SGLT-2 inh. 1. 3-4 non-insulin agents before
consider insulin a. Not SU/GLINIDE b. AACE first
Tier/ Second Tier Principle c. Beta cell-
incretin/SGLT-2 Inh/ Pio d. Resistance- Pio/
metformin e. Other- bromocriptine-QR,
colsevalam F. EARLY TRIPLE THERAPY 2. Incretins
Before Pioglitazone- then dont gain weight from
pioglitazone 3. Ranolazine, SGLT-2 inh to
minimize/prevent edema from pioglitazone 4..
GLP-1 RAs and SGLT-2s have added wt. loss
benefit 5. GLP-1 RAs preferred over DPP-4 in
right patient 6. GLP-1 RAs always before start
Insulin, even a short trial-
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1. Unless sick, avoid insulin if not following
NCS diet2. Keep Non-Insulin treatments as start
basal- Keep on Incretin/SGLT-2 inhibitor
(others) when add insulin if do so only 10
need bolus. If on insulin- as start NCS diet,
decrease 25 if was having hypoglycemia
decrease 25 add
incretin , GLP-1 preferred dec. insulin as do
so add SGLT-2 inhibitor- decrease
insulins 25 add pioglitazone,
metformin, if possible May be able to
stop insulin, lose weight Thus new patients
who come to me on insulin lt40 units/d, not on
diet, hypoglyemia , episodes, I stop insulin
start diet GLP-1 RA and SGLT-2 inhibitor
Weight Reduction Issues- Insulin
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Summary

• Epidemiology and Economics of obesity/diabetes-cos
  tly
• Perspectives on Obesity- culture
• Consequences of Obesity, Prediabetes, Obesity
• Obesity/ Diabetes Risk Factors,
• Obesity/ Diabetes Onset can be Prevented or
  Delayed Early Risk Identification and
  Intervention.
• Medical Benefits to Weight Loss
• Treatment-CDCs diabetes prevention program and
  other Evidence-Based Interventions-
• We can do Better, We must do better