Expert Consensus on Clinical Management of T2DM Combined with Obesity Reversal Treatment in China (2023 Edition)
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Keywords

Type 2 diabetes mellitus (T2DM)
Obesity
Reversal treatment
Clinical management
Expert consensus

DOI

10.26689/par.v7i6.5603

Submitted : 2023-10-23
Accepted : 2023-11-07
Published : 2023-11-22

Abstract

With lifestyle changes, the incidence of type 2 diabetes (T2DM) and obesity has significantly increased, becoming major chronic diseases that seriously threaten the health of China’s residents. Both domestic and international guidelines and consensus exist regarding the diagnosis and management of this disease. In recent years, T2DM treatment has focused more on new tactics that lean towards a patient-centered comprehensive management approach, replacing the traditional glucose-centered approach. Additionally, an increasing amount of evidence in medicine suggests that the reversal of diabetes is possible. However, there is currently no expert consensus on the clinical management of T2DM combined with obesity reversal treatment. Therefore, experts and scholars in China with extensive experience in T2DM combined with obesity reversal treatment have been invited to develop this consensus. The content includes early identification and diagnosis of T2DM combined with obesity, definition and mechanisms of diabetes reversal, disease assessment and grading, staging of diabetes and goals of reversal, the 2+N reversal strategy, inpatient system treatment combined with comprehensive outpatient management (including weight control, precise nutrition, scientific exercise, glucose-lowering medication, psychological intervention, rehabilitation therapy, and remote follow-up through online platforms), and evaluation of post-reversal efficacy. The aim is to further improve the level of T2DM combined with obesity reversal diagnosis, treatment, and management in China, and to implement the Healthy China strategy.

References

Wu J, Guo L, 2022, The Map of Diabetes in China. People’s Health Publishing House, Beijing.

Chen K, Shen Z, Gu W, et al., 2023, Prevalence of Obesity and Associated Complications in China: A Cross-Sectional, Real-World Study in 15.8 Million Adults. Diabetes Obes Metab, 25(11): 3390–3399. https://doi.org/10.1111/dom.15238.

Wang Y, Liang X, Zhou Z, et al., 2022, Prevalence and Numbers of Diabetes Patients with Elevated BMI in China: Evidence from a Nationally Representative Cross-Sectional Study. Int J Environ Res Public Health, 19(5): 2989. https://doi.org/10.3390/ijerph19052989

McCombie L, Leslie W, Taylor R, et al., 2017, Beating Type 2 Diabetes into Remission. BMJ, 358: j4030. https://doi.org/10.1136/bmj.j4030

Ramos-Levi AM, Cabrerizo L, Matia P, et al., 2013, Which Criteria Should be Used to Define Type 2 Diabetes Remission After Bariatric Surgery? BMC Surg, 13: 8. https://doi.org/10.1186/1471-2482-13-8

Klein S, Sheard NF, Pi-Sunyer X, et al., 2004, Weight Management Through Lifestyle Modification for the Prevention and Management of Type 2 Diabetes: Rationale and Strategies. A Statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Am J Clin Nutr, 80(2): 257–263. https://doi.org/10.1093/ajcn/80.2.257

The Diabetes Prevention Program Research Group, 2006, Relationship of Body Size and Shape to the Development of Diabetes in the Diabetes Prevention Program. Obesity (Silver Spring), 14(11): 2107–2117. https://doi.org/10.1038/oby.2006.246

Lake S, Krook A, Zierath JR, 2003, Analysis of Insulin Signaling Pathways Through Comparative Genomics. Mapping Mechanisms for Insulin Resistance in Type 2 (Non-Insulin-Dependent) Diabetes Mellitus. Exp Clin Endocrinol Diabetes, 111(4): 191–197. https://doi.org/10.1055/s-2003-40462

Jensen MD, Ryan DH, Apovian CM, et al., 2014, 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 129(25 Suppl 2): S102–138. https://doi.org/10.1161/01.cir.0000437739.71477.ee

Lastra G, Manrique C, Sowers JR, 2006, Obesity, Cardiometabolic Syndrome, and Chronic Kidney Disease: The Weight of the Evidence. Adv Chronic Kidney Dis, 13(4): 365–373. https://doi.org/10.1053/j,ackd,2006.07.011

Navaneethan SD, Yehnert H, Moustarah F, et al., 2009, Weight Loss Interventions in Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol, 4(10): 1565–1574. https://doi.org/10.2215/CJN.02250409

Indulekha K, Anjana RM, Surendar J, et al., 2011, Association of Visceral and Subcutaneous Fat with Glucose Intolerance, Insulin Resistance, Adipocytokines and Inflammatory Markers in Asian Indians (CURES-113). Clin Biochem, 44(4): 281–287. https://doi.org/10.1016/j.clinbiochem.2010.12.015

Endocrinology Branch of the Chinese Medical Association, 2016, Expert Consensus on Integrating Obesity Management with T2DM in China. Chinese Journal of Diabetes, 8(11): 662–666.

Ji Q, Wu Y, et al., 2022, Expert Consensus on Weight Management for Patients with Type 2 Diabetes. International Journal of Endocrinology and Metabolism, 9: 78–86.

Alberti KG, Zimmet PZ, 1998, Definition, Diagnosis and Classification of Diabetes Mellitus and Its Complications. Part 1: Diagnosis and Classification of Diabetes Mellitus Provisional Report of a WHO Consultation. Diabet Med, 15(7): 539–553. https://doi.org/10.1002/(SICI)1096-9136(199807)15:7<539::AID-DIA668>3.0.CO;2-S

Obesity Group, Endocrinology Branch, Chinese Medical Association, 2011, Consensus of Experts on the Prevention and Treatment of Adult Obesity in China. Chinese Journal of Endocrinology and Metabolism, 27(9): 711–717.

Chinese Diabetes Society, 2021, Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition). Chinese Journal of Diabetes, 13(4): 317–411.

Knowler WC, Barrett-Connor E, Fowler SE, et al., 2002, Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med, 346(6): 393–403. https://doi.org/10.1056/NEJMoa012512

Weng J, 2017, Short?Term Intensive Insulin Therapy Could be the Preferred Option for New Onset Type 2 Diabetes Mellitus Patients with HbA1c > 9. J Diabetes, 9(10): 890–893. https://doi.org/10.1111/1753-0407.12581

Al-Mrabeh A, Zhyzhneuskaya SV, Peters C, et al., 2020, Hepatic Lipoprotein Export and Remission of Human Type 2 Diabetes after Weight Loss. Cell Metab, 31(2): 233–249.e4. https://doi.org/10.1016/j.cmet.2019.11.018

Accili D, Talchai SC, Kim-Muller JY, et al., 2016, When ?-cells Fail: Lessons from Dedifferentiation. Diabetes Obes Metab, 18 Suppl 1(S1): 117–122. https://doi.org/10.1111/dom.12723

Li G, Zhang P, Wang J, et al., 2008, The Long-Term Effect of Lifestyle Interventions to Prevent Diabetes in the China Da Qing Diabetes Prevention Study: A 20-Year Follow-Up Study. Lancet, 371(9626): 1783–1789. https://doi.org/10.1016/S0140-6737(08)60766-7

Gong Q, Gregg EW, Wang J, et al., 2011, Long-Term Effects of a Randomised Trial of a 6-Year Lifestyle Intervention in Impaired Glucose Tolerance on Diabetes-Related Microvascular Complications: The China Da Qing Diabetes Prevention Outcome Study. Diabetologia, 54(2): 300–307.

Li G, Zhang P, Wang J, et al., 2014, Cardiovascular Mortality, All-Cause Mortality, and Diabetes Incidence After Lifestyle Intervention for People with Impaired Glucose Tolerance in the Da Qing Diabetes Prevention Study: A 23-Year Follow-Up Study. Lancet Diabetes Endocrinol, 2(6): 474–480. https://doi.org/10.1016/S2213-8587(14)70057-9

Kramer CK, Zinman B, Retnakaran R, 2013, Short-Term Intensive Insulin Therapy in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis.Lancet Diabetes Endocrinol, 1(1): 28–34. https://doi.org/10.1016/S2213-8587(13)70006-8

Nadkarni P, Chepurny OG, Holz GG, 2014, Regulation of Glucose Homeostasis by GLP-1. Prog Mol Biol Transl Sci, 121: 23–65. https://doi.org/10.1016/B978-0-12-800101-1.00002-8

Bauman WA, Schwartz E, Rose HG, et al., 1988, Early and Long-Term Effects of Acute Caloric Deprivation in Obese Diabetic Subjects. Am J Med, 85(1): 38–46. https://doi.org/10.1016/0002-9343(88)90500-1

Guo J, Chen H, Song J, et al., 2014, Syndrome Differentiation of Diabetes by the Traditional Chinese Medicine According to Evidence-Based Medicine and Expert Consensus Opinion. Evid Based Complement Alternat Med, 2014: 492193. https://doi.org/10.1155/2014/492193

Pang B, Guo J, Zhao L, et al., 2016, Retrospective Study of Traditional Chinese Medicine Treatment of Type 2 Diabetes Mellitus. J Tradit Chin Med, 36(3): 307–313. https://doi.org/10.1016/s0254-6272(16)30042-5

Lv Renhe, Zhao Jinxi, 2009, Diagnosis and Treatment of Diabetes and Its Complications, People’s Medical Publishing House, 209–214.

Case Introduction and Discussion on the Treatment of Extraspinal Soft Tissue Damage Caused by Male Sexual Dysfunction in the Lower Back, Buttocks, Waist and Buttocks or Combined With Soft Tissue Release Surgery at the Base of the Thigh, n.d., Soft Tissue Surgery, 2009, 1141–1149.

Yuan L, 2011, Research Prospects of Fasciology, Tsinghua University Press, 160–174.

Feng R, Wang Z, 2020, Clinical Application of Ultrasound Therapy, Practical Ultrasound Therapy, 59–82.