A comprehensive approach to obesity management and diabetes is essential. The evidence clearly suggests that weight control in overweight and obese patients can delay the progression to type 2 diabetes. It has also been shown to improve glycemic control and reduce the need for glucose-lowering medications in patients diagnosed with diabetes. As a result, a new obesity management section was added to the guidelines. It includes recommendations on diet, physical activity, and behavioral therapies.
Furthermore, obese patients may benefit from pharmacotherapy and/or bariatric surgery. Providers should evaluate their patient’s current drug regimen and if possible, minimize or suggest alternatives to medications that can cause weight gain. They should also consider selecting antidiabetic agents that promote weight loss or are weight neutral. In patients with type 2 diabetes and a BMI ≥27 kg/m2, weight loss medications may be effective as adjuncts to lifestyle modifications. To aid providers in selecting an appropriate agent, a new table of currently approved medications for long-term treatment of obesity is included. This table includes dosing and additional information on orlistat (Alli/Xenical), lorcaserin (Belviq), phentermine/topiramate ER (Qsymia), naltrexone/bupropion (Contrave), and liraglutide (Saxenda).
Consider starting aspirin therapy sooner in women. Low-dose aspirin (75–162 mg/day) as primary prevention for cardiovascular risk reduction remains a controversial topic, both for patients with diabetes and for patients without diabetes. In the 2015 ADA guidelines, it was recommended to consider aspirin therapy in men >50 years and women >60 years who had diabetes and at least one additional major risk factor. This year, the recommendation was changed to include both men and women ≥50 years who are not at risk for bleeding and have at least one additional major risk factor. This stems from recent evidence that reported the risk of heart disease and stroke is equivalent, if not higher, in women compared with men with diabetes.