Diabesity manchester march 2014

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Obesity and Related Conditions 25 March Manchester

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Diabesity manchester march 2014

  1. 1. Action on Diabesity Dr C Rajeswaran Consultant Physician ( Diabetes, Obesity & Endocrinology) Chair, National Diabesity Forum Director, simplyweight Ltd
  2. 2.  Diabesity - 21st century pandemic Diabesity is now the single greatest contributor to chronic disease
  3. 3. Diabesity describes the twin epidemic of obesity and diabetes that we are facing throughout the world. Imagine having "diabesity" and being addicted to alcohol, caffeine nicotine......................“Alconicocafdiabesity?"
  4. 4. Multi hormone control of body weight: Fat,gut and islets derived signals
  5. 5. Obesity and overweight .. conditions in which body fat has accumulated to such an extent that health may be adversely affected (WHO, 2000)
  6. 6. Adjusted odds ratio for death, by metabolic category for 51- 61years age group Diabetes 2.63 Obesity 0.78 Obesity and diabetes 6.81 Oldridge et al, Jr of clinical Epidemiology 54(2001);928-934
  7. 7. Weight gain in patients with type 2 diabetes can contribute to patient frustration and may negatively impact their compliance to therapeutic regimens. F. Xavier Pi-Sunyer, Postgraduate Medicine: Volume 121: No.5 The Impact of Weight Gain on Motivation, Compliance, and Metabolic Control in Patients with Type 2 Diabetes Mellitus
  8. 8. Glycaemic control and body weight Weight gain appears unavoidable when patients with Type 2 diabetes are commenced on insulin Body weight increases by 2Kg for each percentage point decrease in HbA1C during the first year1 .
  9. 9. Diabesity-Management?
  10. 10. Potential benefits of 10kg weight loss in individuals of 100kg
  11. 11. Diabesity Team Endocrinologist Diabesity Nurse specialist Dietitian Physiotherapist occupational therapists Social worker Psychologists Bariatric surgeon
  12. 12. Evaluation: Detailed History Perception Motivation Hunger pattern Body image Glycaemic excursion
  13. 13. Evaluation: Psychological state Anthropometry Problems with ADL (activities of daily living) Mobility Sleep study Endocrine abnormality
  14. 14. Evaluation: In addition to evaluating complications of diabetes, Obesity related complications are assessed
  15. 15. WHY ARE YOU EATING SO FAST?
  16. 16. I WANT TO EAT AS MUCH AS POSSIBLE BEFORE I LOSE MY APPETITE!!
  17. 17. Brain Reward System
  18. 18. Control of appetite
  19. 19. Genes and Weight Genes Environment 40%60%
  20. 20. Drug Class May cause Weight gain Less weight gain, weight loss or weight neutral Antipsychotics Clozapine Risperidone Olanzipine Ziprasidone Aripiprazole Antidepressants and Mood stabilizers Citalopram Lithium MAOIs TCAs Venlafaxine Mirtazapine Paroxetine Bupropion Sertraline Fluoxetine Anticonvulsants Carbamazepine Gabapentin Valproate Lamotrigine Topiramate Diabetes Drugs Insulin Sulphonylureas Thiazolidinediones Metformin Acarbose GLP-1 DDPIV Antihypertensives Alpa blockers Beta blockers ACE inhibitors Calcium Channel Blockers Oral Contraceptives Progesterone only pill Combination pill with progesterone Barrier method IUDs
  21. 21. Understanding Hunger Pattern NEAT: Non exercise activity thermogenesis Dieting cause weight gain
  22. 22. Surgery Effective Early Intervention for Diabesity
  23. 23. Gastric balloon
  24. 24. http://www.healthierweight.co.uk/obesity-surgery/gastric-band/what-is-a-gastric-band/how-does-the-band-work/ Gastric Banding
  25. 25. SA 46 years male Type 2 Diabetes (2002) Morbid Obesity Metformin 2.5 gms Insulin 180 units
  26. 26. Examination: Weight 164Kg (25.82 Stones) Rest of examination unremarkable
  27. 27. Child hood…….. Puberty……… Family……… Social history…….. Personal history…….. H/O weight loss management & medical history
  28. 28. Investigations: No evidence of Obstructive sleep apnoea HbA1c-11.2% Testosterone 6 nmol/l SHBG 26 LH 2.1 FSH 1.3
  29. 29. Management Testosterone 5gm gel OD Calorie restriction Clinic follow up Weight 148 Kg (Initial wt 164) NOT tired, No day time sleepiness Insulin160 units a day HbA1c 10.2%
  30. 30. Exenatide introduced And Insulin gradually weaned off Under very close supervision
  31. 31. Clinic( 6 months) 119Kg (Initial wt -164Kg) HbA1c - 8%
  32. 32. •Not every option is appropriate for every individual. •Holistic approach is the key in a DIABESITY Clinic Glycaemic control Body weight and hunger pattern Psychological issues Underlying endocrine abnormalities
  33. 33. “ Of course doughnuts are good for you. They’re HOLE grain!”
  34. 34. Thank you!

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