GOALS FOR MEDICAL TREATMENT IN OBESITY AND PREDIABETES: IMPROVING OUTCOMES FOR BOTH.

OBJECTIVE: The purpose of this review is to expose the surprising prevalence of diabetes-related complications in people with persistent prediabetes, and hence, to expand the paradigm of diabetes prevention to include the prevention of complications related to both hyperglycemia and obesity.

METHODS: Published literature was reviewed.

RESULTS: Approximately 84 million Americans have prediabetes, 85% of whom are overweight or obese. Although the incidence of diabetes-related complications is lower in people with prediabetes vs. type 2 diabetes, the overall prevalence is virtually identical. Further, many people with prediabetes not only suffer from the complications of related to hyperglycemia, they also experience complications of obesity. Treating obesity as a disease has the potential to prevent complications of both hyperglycemia and obesity. Emerging data reveals the untapped potential for clinicians to enhance the effectiveness of anti-obesity medications through a mindful health care delivery style. This involves an understanding and ethical utilization of the placebo effect in conjunction with active medical therapy. This approach is not intended to mislead patients, but rather to activate neurocircuitry that synergizes with the central action of the approved anti-obesity medications to potentiate weight loss.

CONCLUSIONS: Mindful administration of anti-obesity medications has the potential for widespread health benefits in people with obesity and prediabetes.

ABBREVIATIONS: ADA = American Diabetes Association; AACE = American Association of Clinical Endocrinologists; DPP = Diabetes Prevention Program; DPPOS = Diabetes Prevention Program Outcomes Study; MVD = Microvascular disease; CVD = Cardiovascular disease; NDPP = National Diabetes Prevention Program; CDC = Centers for Disease Control; eGFR = Estimated glomerular filtration rate; TZD = Thiazolidinedione; SGLT2 Sodium-glucose-like cotransporter-2.