Rothberg A. McEwen L. Et Al. Journal of Diabetes and Its Complications. Doi: 10.1016/j.jdiacomp.2014.03.014
Obese patients with type 2 diabetes represent a major management problem in modern clinical practice. Currently we can offer them lifestyle advice, pharmacological intervention and for a very small minority, bariatric surgery. We need to continually improve our therapeutic armoury and this paper suggests a possible route. It’s neither new nor a dramatic breakthrough and as the title suggests, perhaps more intensive lifestyle intervention is overlooked in our regular daily practice. Working with outpatients and invoking a regime of a tough low energy diet produced significant results. In addition physical activity was also encouraged to dovetail with the dietary intervention. Encouragingly after three months, variables such as BMI and HbA1 dropped significantly. Now of course this was a small trial, only 66 people over a short period of time but it is a good reminder of going back to basics. But this type of intervention involves a significant patient commitment which will not suit everybody and it will require staff with time and interest to monitor, encourage and interact with the patients.