1.0.0.0 In­tro­duc­tion

The Amer­i­can Di­a­betes As­so­ci­a­tion (ADA) “Stan­dards of Med­i­cal Care in Di­a­betes” in­cludes ADA’s cur­rent clin­i­cal prac­tice rec­om­men­da­tions and is in­tend­ed to pro­vide the com­po­nents of di­a­betes care, gen­er­al treat­ment goals and guide­lines, and tools to eval­u­ate qual­i­ty of care. Mem­bers of the ADA Pro­fes­sion­al Prac­tice Com­mit­tee, a mul­ti­dis­ci­plinary ex­pert com­mit­tee, are re­spon­si­ble for up­dat­ing the Stan­dards of Care an­nu­al­ly, or more fre­quent­ly as war­rant­ed. For a de­tailed de­scrip­tion of ADA stan­dards, state­ments, and re­ports, as well as the ev­i­dence-‍grad­ing sys­tem for ADA’s clin­i­cal prac­tice rec­om­men­da­tions, please refer to the Stan­dards of Care In­tro­duc­tion. Read­ers who wish to com­ment on the Stan­dards of Care are in­vit­ed to do so at pro­fes­sion­al.di­a­betes.org/‍SOC.

There is strong and con­sis­tent ev­i­dence that obe­si­ty man­age­ment can delay the pro­gres­sion from predi­a­betes to type 2 di­a­betes (1-5) and is beneficial in the treat­ment of type 2 di­a­betes (6-17). In pa­tients with type 2 di­a­betes who are over­weight or obese, mod­est and sus­tained weight loss has been shown to im­prove glycemic con­trol and to re­duce the need for glu­cose-‍low­er­ing med­i­ca­tions (6-8). Small stud­ies have demon­strat­ed that in pa­tients with type 2 di­a­betes and obe­si­ty, more ex­treme di­etary en­er­gy re­stric­tion with very low-‍calo­rie diets can re­duce A1C to <6.5% (48 mmol/‍mol) and fast­ing glu­cose to <126 mg/dL (7.0 mmol/‍L) in the ab­sence of phar­ma­co­log­ic ther­a­py or on­go­ing pro­ce­dures (10,18,19). Weight loss–in­duced im­provements in glycemia are most like­ly to occur early in the nat­u­ral his­to­ry of type 2 di­a­betes when obe­si­ty-‍as­so­ci­at­ed in­sulin re­sis­tance has caused re­versible β-cell dys­func­tion but in­sulin se­cre­to­ry ca­pac­i­ty re­mains rel­a­tive­ly pre­served (8,11,19,20). The goal of this sec­tion is to pro­vide ev­i­dence-‍based rec­om­men­da­tions for weight-‍loss ther­a­py, in­clud­ing diet, be­hav­ioral, phar­ma­co­log­ic, and sur­gi­cal in­ter­ven­tions, for obe­si­ty man­age­ment as treat­ment for hy­per­glycemia in type 2 di­a­betes.