Résumé
The vast majority of patients with type 2 diabetes (T2DM) are overweight or obese. Overweight is associated with cardiovascular risk factors and an increased risk of cardiovascular morbidity and mortality in T2DM. Weight loss delays or prevents T2DM in prediabetes, and improves glycemic control, in overt T2DM. Weight loss was also associated with a reduction in cardiovascular risk factors in several observational studies.
However, the only randomized trial conducted among overweight or obese patients with T2DM (Look AHEAD) has shown the difficulty in maintaining a significant weight loss in the long term and to demonstrate a beneficial effect of weight loss on cardiovascular morbidity and mortality.
Most interventional studies show a reduction of sleep apnea, improvedmetabolic control, prevention of depression, improved quality of life and greater mobility after sustained weight loss inpatients with T2DM.,The substantial weight loss obtained by bariatric surgery is associated with a reduction in overall cardiovascular morbidity and mortality in the long term, therefore this option must be considered early enough in the management of obese T2DM patients, particularly in those not responding to education and intensive monitoring.
Physicians should therefore promote a sustained weight loss in all T2DM patients in order of benefit to the individual beyond the current lack of evidence on the benefits of lifestyle management in terms of cardiovascular morbidity and mortality.