Diabetes & Metabolism Journal

Reviews

Lifestyle
Type 2 Diabetes Mellitus and Sarcopenia as Comorbid Chronic Diseases in Older Adults: Established and Emerging Treatments and Therapies: Jakub Mesinovic, Jackson J. Fyfe, Jason Talevski, Michael J. Wheeler, Gloria K.W. Leung, Elena S. George, Melkamu T. Hunegnaw, Costas Glavas, Paul Jansons, Robin M. Daly, David Scott; Diabetes Metab J. 2023;47(6):719-742. Published online September 14, 2023; DOI: https://doi.org/10.4093/dmj.2023.0112

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Type 2 diabetes mellitus (T2DM) and sarcopenia (low skeletal muscle mass and function) share a bidirectional relationship. The prevalence of these diseases increases with age and they share common risk factors. Skeletal muscle fat infiltration, commonly referred to as myosteatosis, may be a major contributor to both T2DM and sarcopenia in older adults via independent effects on insulin resistance and muscle health. Many strategies to manage T2DM result in energy restriction and subsequent weight loss, and this can lead to significant declines in muscle mass in the absence of resistance exercise, which is also a first-line treatment for sarcopenia. In this review, we highlight recent evidence on established treatments and emerging therapies targeting weight loss and muscle mass and function improvements in older adults with, or at risk of, T2DM and/or sarcopenia. This includes dietary, physical activity and exercise interventions, new generation incretin-based agonists and myostatin-based antagonists, and endoscopic bariatric therapies. We also highlight how digital health technologies and health literacy interventions can increase uptake of, and adherence to, established and emerging treatments and therapies in older adults with T2DM and/or sarcopenia.

Citations

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Fucoidan ameliorates diabetic skeletal muscle atrophy through PI3K/Akt pathway
Caixia Li, Yaping Liu, Mingzhi Yang, Haoyue Huang, Lulu Tang, Yufan Miao, Wenjie Li, Xing Li
Journal of Functional Foods.2024; 114: 106076. CrossRef

Guideline/Fact Sheet
Comprehensive Understanding for Application in Korean Patients with Type 2 Diabetes Mellitus of the Consensus Statement on Carbohydrate-Restricted Diets by Korean Diabetes Association, Korean Society for the Study of Obesity, and Korean Society of Hypertension: Jong Han Choi, Jee-Hyun Kang, Suk Chon; Diabetes Metab J. 2022;46(3):377-390. Published online May 25, 2022; DOI: https://doi.org/10.4093/dmj.2022.0051

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The Joint Committee of the Korean Diabetes Association, the Korean Society for the Study of Obesity, and the Korean Society of Hypertension announced a consensus statement on carbohydrate-restricted diets and intermittent fasting, representing an emerging and popular dietary pattern. In this statement, we recommend moderately-low-carbohydrate or low-carbohydrate diets, not a very-low-carbohydrate diet, for patients with type 2 diabetes mellitus. These diets can be considered a dietary regimen to improve glycemic control and reduce body weight in adults with type 2 diabetes mellitus. This review provides the detailed results of a meta-analysis and systematic literature review on the potential harms and benefits of carbohydrate-restricted diets in patients with diabetes. We expect that this review will help experts and patients by fostering an in-depth understanding and appropriate application of carbohydrate-restricted diets in the comprehensive management of diabetes.

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Efficacy of convenience meal-type foods designed for diabetes in the management of metabolic syndrome based on a 3-week trial
Do Gyeong Lee, In Gyeong Kang, Tae Seok Kim, Yun Ahn, Sang Yun Lee, Hye Jin Ahn, Yoo Kyoung Park
Nutrition.2024; 118: 112287. CrossRef
Long-Term Results of a Digital Diabetes Self-Management and Education Support Program Among Adults With Type 2 Diabetes: A Retrospective Cohort Study
Ashley Berthoumieux, Sarah Linke, Melinda Merry, Alison Megliola, Jessie Juusola, Jenna Napoleone
The Science of Diabetes Self-Management and Care.2024; 50(1): 19. CrossRef
Medical nutrition therapy for diabetes mellitus
Suk Chon
Journal of the Korean Medical Association.2023; 66(7): 421. CrossRef

Drug/Regimen
Comprehensive Review of Current and Upcoming Anti-Obesity Drugs: Jang Won Son, Sungrae Kim; Diabetes Metab J. 2020;44(6):802-818. Published online December 23, 2020; DOI: https://doi.org/10.4093/dmj.2020.0258

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Obesity is among the leading causes of morbidity and mortality worldwide and its prevalence continues to increase globally. Because obesity is a chronic, complex, and heterogeneous disease influenced by genetic, developmental, biological, and environmental factors, it is necessary to approach obesity with an integrated and comprehensive treatment strategy. As it is difficult to achieve and sustain successful long-term weight loss in most patients with obesity through lifestyle modifications (e.g., diet, exercise, and behavioral therapy), pharmacological approaches to the treatment of obesity should be considered as an adjunct therapy. Currently, four drugs (orlistat, naltrexone extended-release [ER]/bupropion ER, phentermine/topiramate controlled-release, and liraglutide) can be used long-term (>12 weeks) to promote weight loss by suppressing appetite or decreasing fat absorption. Pharmacotherapy for obesity should be conducted according to a proper assessment of the clinical evidence and customized to individual patients considering the characteristics of each drug and comorbidities associated with obesity. In this review, we discuss the mechanisms of action, efficacy, and safety of these available long-term anti-obesity drugs and introduce other potential agents under investigation. Furthermore, we discuss the need for research on personalized obesity medicine.

Citations

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A review of an investigational drug retatrutide, a novel triple agonist agent for the treatment of obesity
Manmeet Kaur, Saurav Misra
European Journal of Clinical Pharmacology.2024; 80(5): 669. CrossRef
Gut microbiota and therapy for obesity and type 2 diabetes
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Adipocyte-targeted delivery of rosiglitazone with localized photothermal therapy for the treatment of diet-induced obesity in mice
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Efficacy of endoscopic resuturing versus pharmacotherapy to treat weight recidivism after endoscopic sleeve gastroplasty
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Gastrointestinal Endoscopy.2023; 98(6): 944. CrossRef
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From Metabolic Syndrome to Type 2 Diabetes in Youth
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Excess body weight: Novel insights into its roles in obesity comorbidities
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Striatal dopamine D2-like receptors availability in obesity and its modulation by bariatric surgery: a systematic review and meta-analysis
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Cost-effectiveness analysis of five anti-obesity medications from a US payer's perspective
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Analysis of Serious Weight Gain in Patients Using Alectinib for ALK-Positive Lung Cancer
Simon P. de Leeuw, Melinda A. Pruis, Barend J. Sikkema, Mostafa Mohseni, G. D. Marijn Veerman, Marthe S. Paats, Daphne W. Dumoulin, Egbert F. Smit, Annemie M.W. J. Schols, Ron H.J. Mathijssen, Elisabeth F.C. van Rossum, Anne-Marie C. Dingemans
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Role of flavonoids in controlling obesity: molecular targets and mechanisms
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The N-degron pathway mediates lipophagy: The chemical modulation of lipophagy in obesity and NAFLD
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Bupropion Mediated Effects on Depression, Attention Deficit Hyperactivity Disorder, and Smoking Cessation
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Management of abdominal wall hernias in patients with severe obesity
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Surgical Endoscopy.2023; 37(9): 6619. CrossRef
Obesity-related hypertension and chronic kidney disease: from evaluation to management
Mi-Hyang Jung, Sang-Hyun Ihm
Kidney Research and Clinical Practice.2023; 42(4): 431. CrossRef
Antiepileptics pharmacotherapy or antidiabetics may hold potential in ‎treatment of ‎‎epileptic ‎patients with diabetes mellitus: A narrative review
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Hacettepe University Journal of the Faculty of Pharmacy.2023;[Epub] CrossRef
Medicamentos antidiabéticos utilizados com a finalidade de perda de peso
Sâmia Moreira de ANDRADE, Maria Victória Macedo de ANDRADE, Pedro Henrique Almeida de FARIA, Luís Marcelo Vieira ROSA, Plínio Robson Cavalcante COSTA, Luiz Gustavo Freitas PIRES
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Treatment of hypothalamic obesity in people with hypothalamic injury: new drugs are on the horizon
Christian L. Roth, Anna Zenno
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Obesity: What’s Old, What’s New and How We Manage It: An Integrated Approach in Pharmacy Practice
Ângelo Jesus
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Integrating Pharmacotherapy and Psychotherapy for Weight Loss
Marla Sanzone, Morgan Sammons
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Effect of Lingguizhugan decoction in activating fat mobilization in obesity
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Delivery of miRNAs to the adipose organ for metabolic health
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Russelioside B: a Pregnane Glycoside with Pharmacological Potential
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Original Articles

Obesity and Metabolic Syndrome
Air Pollution Has a Significant Negative Impact on Intentional Efforts to Lose Weight: A Global Scale Analysis: Morena Ustulin, So Young Park, Sang Ouk Chin, Suk Chon, Jeong-taek Woo, Sang Youl Rhee; Diabetes Metab J. 2018;42(4):320-329. Published online April 24, 2018; DOI: https://doi.org/10.4093/dmj.2017.0104

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Abstract PDF PubReader

Background

Air pollution causes many diseases and deaths. It is important to see how air pollution affects obesity, which is common worldwide. Therefore, we analyzed data from a smartphone application for intentional weight loss, and then we validated them.

Methods

Our analysis was structured in two parts. We analyzed data from a cohort registered to a smartphone application in 10 large cities of the world and matched it with the annual pollution values. We validated these results using daily pollution data in United States and matching them with user information. Body mass index (BMI) variation between final and initial login time was considered as outcome in the first part, and daily BMI in the validation. We analyzed: daily calories intake, daily weight, daily physical activity, geographical coordinates, seasons, age, gender. Weather Underground application programming interface provided daily climatic values. Annual and daily values of particulate matter PM10 and PM2.5 were extracted. In the first part of the analysis, we used 2,608 users and then 995 users located in United States.

Results

Air pollution was highest in Seoul and lowest in Detroit. Users decreased BMI by 2.14 kg/m² in average (95% confidence interval, −2.26 to −2.04). From a multilevel model, PM10 (β=0.04, P=0.002) and PM2.5 (β=0.08, P<0.001) had a significant negative effect on weight loss when collected per year. The results were confirmed with the validation (β_AQI*time=1.5×10^–5; P<0.001) by mixed effects model.

Conclusion

This is the first study that shows how air pollution affects intentional weight loss applied on wider area of the world.

Citations

Citations to this article as recorded by

What could be the reasons for not losing weight even after following a weight loss program?
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Subchronic exposure to 1,2-naphthoquinone induces adipose tissue inflammation and changes the energy homeostasis of mice, partially due to TNFR1 and TLR4
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Effects of Ambient Particulate Matter (PM2.5) Exposure on Calorie Intake and Appetite of Outdoor Workers
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Appropriate Medical Technology in the Era of the 4th Industrial Revolution
Sang Youl Rhee
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Can Air Pollution Biologically Hinder Efforts to Lose Body Weight?
Duk-Hee Lee
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Obesity and Metabolic Syndrome
Importance of Lean Muscle Maintenance to Improve Insulin Resistance by Body Weight Reduction in Female Patients with Obesity: Yaeko Fukushima, Satoshi Kurose, Hiromi Shinno, Ha Cao Thu, Nana Takao, Hiromi Tsutsumi, Yutaka Kimura; Diabetes Metab J. 2016;40(2):147-153. Published online March 27, 2016; DOI: https://doi.org/10.4093/dmj.2016.40.2.147

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Abstract PDF PubReader

Background

It has recently been suggested that skeletal muscle has an important role in insulin resistance in obesity, in addition to exercise tolerance and the fat index. The aim of this study was to identify body composition factors that contribute to improvement of insulin resistance in female patients with obesity who reduce body weight.

Methods

We studied 92 female obese patients (age 40.9±10.4 years, body mass index 33.2±4.6 kg/m²) who reduced body weight by ≥5% after an intervention program including diet, exercise therapy, and cognitive behavioral therapy. Before and after the intervention, body composition was evaluated by dual-energy X-ray absorptiometry to examine changes in skeletal muscle mass. Homeostasis model assessment of insulin resistance (HOMA-IR) was measured as an index of insulin resistance. Cardiopulmonary exercise was also performed by all patients.

Results

There were significant improvements in body weight (–10.3%±4.5%), exercise tolerance (anaerobic threshold oxygen uptake 9.1%±18.4%, peak oxygen uptake 11.0%±14.2%), and HOMA-IR (–20.2%±38.3%). Regarding body composition, there were significant decreases in total body fat (–19.3%±9.6%), total fat-free mass (–2.7%±4.3%), and % body fat (–10.1%±7.5%), whereas % skeletal muscle significantly increased (8.9%±7.2%). In stepwise multiple linear regression analysis with change in HOMA-IR as the dependent variable, the change in % skeletal muscle was identified as an independent predictor (β=–0.280, R²=0.068, P<0.01).

Conclusion

Improvement of insulin resistance in female obese patients requires maintenance of skeletal muscle mass.

Citations

Citations to this article as recorded by

Sarcopenia prevalence between obese and morbid obese patients in an obesity center
Mujgan Tuna, Arzu Cennet Işık , Ozlem Hürmeydan
Journal of Surgery and Medicine.2024; 8(4): 73. CrossRef
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The Small Rice Bowl-Based Meal Plan was Effective at Reducing Dietary Energy Intake, Body Weight, and Blood Glucose Levels in Korean Women with Type 2 Diabetes Mellitus: Hee Jung Ahn, Kyung Ah Han, Hwi Ryun Kwon, Kyung Wan Min; Korean Diabetes J. 2010;34(6):340-349. Published online December 31, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.6.340

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Abstract PDF PubReader

Background

The typical Korean diet includes rice, which is usually served in a rice bowl. We investigated the effects of a meal plan using rice bowls of varying sizes on dietary energy intake (EI), body weight (BW), and blood glucose levels.

Methods

Forty-two obese women with type 2 diabetes mellitus were randomly assigned to use either a 200 mL small rice bowl (SB), a 380 mL regular rice bowl (RB), or to a control group (C). Both intervention groups were asked to reduce their EI by 500 kcal/day for 12 weeks and simple instructions for using the assigned bowl were provided. Dietary EI and proportion of macronutrients (PMN) were estimated from 3-day dietary records.

Results

Reduction of EI was more prominent in the SB group compared to the RB and C group, although EI decreased significantly from baseline in all groups. Carbohydrate and fat intakes of the SB group were decreased greater than those of the RB and C group. However, changes in PMN were not significant across the 3 groups. Reduction of BW and HbA1c levels in the SB group was more prominent compared to the C group. Although, BW and HbA1c were decreased significantly from baseline in both bowl groups. There was no statistical difference between the two groups.

Conclusion

The small rice bowl-based meal plan was effective at reducing EI, BW, and blood glucose levels, and the observed reductions in EI, carbohydrate, and fat intake were greater than those of the regular rice bowl-based meal plan.

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Small Rice Bowl-Based Meal Plan versus Food Exchange-Based Meal Plan for Weight, Glucose and Lipid Control in Obese Type 2 Diabetic Patients: Hee-Jung Ahn, Kyung-Ah Han, Hwi-Ryun Kwon, Bo-Kyung Koo, Hyun-Jin Kim, Kang-Seo Park, Kyung-Wan Min; Korean Diabetes J. 2010;34(2):86-94. Published online April 30, 2010; DOI: https://doi.org/10.4093/kdj.2010.34.2.86

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Abstract PDF PubReader

Background

The Korean National Health and Nutrition Examination Surveys reported 65% of daily energy intake (EI) as carbohydrate (CHO) in the Korean population and main source of CHO was cooked rice. We used a standardized-small sized rice bowl for diet education and investigated its effectiveness on body weight, glucose and lipid, compared to the conventional food exchange system in type 2 diabetes obese women.

Methods

Type 2 diabetic women with body mass index ≥ 23 kg/m² were randomly assigned to small rice bowl-based meal plan (BM) and food exchange-based meal plan (ExM) group. Both groups were asked to reduce their EI by 500 kcal/day for 12 weeks. The macronutrient composition was instructed: 55 to 60% of EI as CHO, 15 to 20% as protein, and 20 to 25% as fat. BM group received only a simple instruction for application of the rice bowl. Nutrient intake was estimated with the 3-day dietary records.

Results

Finally, 44 subjects finished the study. The percent reduction of body weight was significant both BM group (-5.1 ± 2.6%) and ExM group (-4.8 ± 2.8%) after 12 weeks (P < 0.001) but there was no difference between the groups. There was no difference in the proportional change of CHO, protein and fat in EI between the groups. Additionally, the change of HbA1c and low density lipoprotein-cholesterol were not significantly different between the two groups.

Conclusion

The BM group was as effective as ExM for body weight and glucose control in type 2 diabetes obese women.

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Hee Jung Ahn, Kyung Ah Han, Jin Young Jang, Jae Hyuk Lee, Kang Seo Park, Kyung Wan Min
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The Small Rice Bowl-Based Meal Plan was Effective at Reducing Dietary Energy Intake, Body Weight, and Blood Glucose Levels in Korean Women with Type 2 Diabetes Mellitus
Hee Jung Ahn, Kyung Ah Han, Hwi Ryun Kwon, Kyung Wan Min
Korean Diabetes Journal.2010; 34(6): 340. CrossRef

Randomized Controlled Trial

The Effects of Low-Calorie Diets on Abdominal Visceral Fat, Muscle Mass, and Dietary Quality in Obese Type 2 Diabetic Subjects.: Hee Jung Ahn, Youn Ok Cho, Hwi Ryun Kwon, Yun Hyi Ku, Bo Kyung Koo, Kyung Ah Han, Kyung Wan Min; Korean Diabetes J. 2009;33(6):526-536. Published online December 1, 2009; DOI: https://doi.org/10.4093/kdj.2009.33.6.526

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Abstract PDF

BACKGROUND
Weight loss through low-calorie diets (LCDs) decreases visceral fat (VF). However, the effects on muscle mass, changes of dietary quality, and insulin sensitivity are unknown for Korean obese type 2 diabetic subjects. Therefore, this study examined such effects of LCDs. METHODS: A total of 30 obese type 2 diabetic subjects (body mass index, 27.0 +/- 2.2 kg/m2) were randomly assigned to an LCD or control group. Subjects on LCDs took 500~1,000 kcal fewer energy than their usual dietary intake (1,000~1,500 kcal/day) over the course of 12 weeks. The abdominal VF and femoral muscle mass were evaluated by computed tomography, and insulin sensitivity was assessed using an insulin tolerance test (Kitt; rate constant for plasma glucose disappearance, %/min). Dietary nutrient intake consumed by subjects was assessed by 3-day food records. RESULTS: The percent VF reduction was -23.4 +/- 17.2% in the LCD group and -9.8 +/- 11.8% in the control group after 12 weeks (P < 0.001, P = 0.002). However, significant decrease in femoral mass or proportional change of marcronutrient intake and mean adequacy ratio were not found in the LCD group, as compared to the control group. Insulin sensitivity improved in the LCD group, as compared to the control group (P = 0.040). CONCLUSION: LCD effectively improved insulin sensitivity and reduced abdominal VF without reduction of femoral muscle and dietary quality in obese type 2 diabetic subjects.

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The Usefulness of an Accelerometer for Monitoring Total Energy Expenditure and Its Clinical Application for Predicting Body Weight Changes in Type 2 Diabetic Korean Women
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The Effects of Low-Calorie Diets on Abdominal Visceral Fat, Muscle Mass, and Dietary Quality in Obese Type 2 Diabetic Subjects (Korean Diabetes J 2009;33:526-36)
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Original Article

Prevention of Diabetes by Fenofibrate in OLETF Rats: Hepatic Mechanism for Reducing Visceral Adiposity.: Hye Jeong Lee, Mi Kyoung Park, Kyung Il Lee, Young Jun An, Ji Min Kim, Ja Young Park, Young Han, Sook Hee Hong, Sun Seob Choi, Young Hyun Yoo, Joon Duk Suh, Duk Kyu Kim; Korean Diabetes J. 2007;31(1):63-74. Published online January 1, 2007; DOI: https://doi.org/10.4093/jkda.2007.31.1.63

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Abstract PDF

BACKGROUND
The aim of this study is to evaluate the hepatic mechanism of fenofibrate that has the diabetes protective action in rats. METHODS: We chose OLETF rats and divided them into three groups. Fenofibrate (DF) group was fed with diet and fenofibrate (300 mg/kg/day). Paired feeding (Dd) group and free diet (DD) group were fed with diet. After 36 weeks of treatment, all the rats were sacrificed. RESULTS: The fasting blood glucose level of DF group (8.5 +/- 0.9 mmol/L) showed normal. The fasting blood glucose level of Dd group (22.4 +/- 3.0 mmol/L) and DD group (16.9 +/- 3.7 mmol/L) showed significantly increased than that of DF group (P < 0.01, respectively). The body weight, visceral adipose tissue and subcutaneous adipose tissue of DF group were significantly decreased compared to those of Dd and DD groups (P < 0.01, P < 0.05, P < 0.05). DF group showed significantly increased state-3 respiration rate, ATP synthetic activity, state-4 respiration rate and their blood beta-keton body levels than those of control groups (P < 0.01, respectively). DF group showed normal morphology of hepatocytes but DD and Dd groups showed hepatic steatosis with mitochondrial swellings. CONCLUSION: Chronic fenofibrate treatment prevents the development of diabetes in OLETF rats with inhibiting gain of body weight and abdominal adiposity. The hepatic mechanism for reducing visceral adiposity is that fenofibrate leads to increasing oxidative phosphorylation, uncoupling and ketogenesis as well as increasing beta-oxidation of fatty acids. Moreover, fenofibrate treatment prevents the development of hepatic steatosis.

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Journal of the Korean Society of Food Science and Nutrition.2012; 41(8): 1086. CrossRef
Comparative analysis of fat and muscle proteins in fenofibratefed type II diabetic OLETF rats: the fenofibrate-dependent expression of PEBP or C11orf59 protein
Jong-Ryeal Hahm, Jin-Sook Ahn, Hae-Sook Noh, Seon-Mi Baek, Ji-Hye Ha, Tae-Sik Jung, Yong-Jun An, Duk-Kyu Kim, Deok-Ryong Kim
BMB Reports .2010; 43(5): 337. CrossRef
Comparative analysis of fat and muscle proteins in fenofibratefed type II diabetic OLETF rats: the fenofibrate-dependent expression of PEBP or C11orf59 protein
Jong-Ryeal Hahm, Jin-Sook Ahn, Hae-Sook Noh, Seon-Mi Baek, Ji-Hye Ha, Tae-Sik Jung, Yong-Jun An, Duk-Kyu Kim, Deok-Ryong Kim
BMB Reports.2010; 43(5): 337. CrossRef

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