Lifestyle modification is pretty challenging as we all know we are a society with fast food restaurants around us and we refuse to be active and engage in daily exercise. I personally thing once weekly Wegovy is good for type 2 DM with morbid obesity not only for its CV benefit but robust weight loss #

What other drugs taken in addition to antidiabetic agents lead to weight gain (e.g., antidepressants)? How do you manage weight concerns in such patients?

sulfonylureas are a problem. rybelsus

I agree that obesity and diabetes are risk factors for CV disease. Add to that smoking status then that patient is really put at higher risk. Prevention, screening, and lifestyle modification are important in treating patients. There are several challenges in achieving weight loss - such as patient's resistance to practice healthy lifestyle which could be to a lot of reasons. Medication compliance can also be an issue, especially taking into consideration potential side effects.

pharmacology helps move a patient more quickly to their measurable goals but the lifestyle changes are the long term goal and treatment to manage disease and prevent complications. the 2 can work well together

My main challenge is to find time to discuss weight loss when I’m seeing pts with multiple comorbidities and uncontrolled diabetes, also high cost of newer medications and compliance with diet and exercise regimen. I prefer using GLP-1 analogs for weight loss.

patient compliance with lifestyle modification
sglt2 and glp1 are great for weight control in addition to lowering hgba1c

also, education regarding appropriate medications my reduce need for insulin and help promote more stable blood sugars along with weight loss

education in healthy food choices that do not raise the blood sugars as much and require less insulin plus increased activity will help reduce the weight gain and lead to weight loss

agree with everyone

So many patients suffer with inability to lose weight and constant gain

What are the positives and negatives of pharmacotherapy for T2DM? Have you had patients who have successfully instituted lifestyle changes (e.g., diet, exercise) and no longer needed pharmacotherapy? If so, please describe.

most weight loss medications are not covered and pts have no access to a dietician in my area, time restrains are not allowing to focus mainly on weight loss because I have to take care of multiple endocrine problems
I am using mainly GLP-1 analogs and SGLT-2 inhibitors, looking forward to using recently approved Mounjaro once available at the pharmacies

Drugs that are beneficial in achieving weight loss as well as glycemic control such as ozempic or victoza are often more expensive than other older drugs. Patient buy in is a huge problem for me.

very good

1. My patients enjoy food and find comfort in non-healthy meals. It makes them happy especially when social aspects of engagement have been limited because of the pandemic. This the greatest challenge in our current climate and as we are starting to see patients travel more as the economy opens up and has become more of challenge.
2. Medications such as sulfonyureas and insulin should be used with caution with obese patients

The challenge remains durability to lifestyle changes and medication related weight loss given the easily and frequently consumed processed foods. Metformin and SGLT2 show modest weight loss at best with some hyperresponders to GLP1

In our rural area, diet is far from ideal... just encourage more fruits and if no CKD; Ozempic;

Of course diet and exercise is recommended for all diabetics and obese patients. Ozempic, especially because it's only a once a week, painless injection,has helped tremendously to help both of these areas.

Managing Diabetes and the related Obesity is a life long challenge for both the patients and the Health Care Providers and is governed by the multiple factors of Patients perception of the disease process , comorbid factors , economy , tolerance of the meds , compliance , complacency and preference of the meds . Managing Diabetes and Obesity has never been so promosing than ever before thanks to GLP-1 Agonist and the SGLT-2 inhibitors and slew of meds in the pipeline . Patients need to be monitored and motivated on long term basis to follow the diet and exercise program and now with the help of plethora of the apps available helps a lot for the BioFeedback in managing the Blood Glucose and weight , Use of the Continous Glucose monitors has become in vogue thanks to much better coverage by the insurance companies , GLP-1 in particular the Availablity of Oral Rybelsus has been a shot in the arm of the use of this class with much wider acceptability of these meds and have helped lot of diabetic pts to achieve better glucose control and weight loss with signficant potential for positive Cardiovascular outcomes as supported by the data , Ofcourse the injectables in this class are always there for the pts who prefer them There is always room for the addition of SGLT-2 inhibitors in the life long management of diabetes and they become drugs of choice in pts with and with risk for Cardiovascular disease , Mefformin remains the cornerstone med to manage the Insulin Resistance and should be always there even and unlness not possible due to intolerance , Bariatric Surgery should be pursued whenever possible and indicated as has the potential of "curing "diabetes given the sophistaication and safety that is now there in this modality . Overall affording the meds tolerance and compliance remain the main challenges in managing diabetes and obesity

What is the combined benefit of pharmacotherapy and lifestyle change in patients with diabetes and hypertension? Does this combination further potentiate health outcomes?

the challenges in weight loss or or wheeze the patient losing the weight and keeping the weight off even with GLP-1 they tend to plateau over time and the medication does not appear to have the same effect down the line as it does at the initial visit and need to increase ever increasingly dosages of GLP-1 in order to gain the same favorable effect.

1. The obese patient has habits and lifestyle that make achievable, sustainable weight loss difficult. If they have already advanced to insulin, then the weight gain associated with a necessary medication must be overcome as well. So, lifestyle, eating habits, medications, and comorbidities, must all be manipulated and eventually balanced to achieve weight control.
2. Currently, the most promising drugs available are the GLP-2 inhibitors.

1. The obese patient has habits and lifestyle that make achievable, sustainable weight loss difficult. If they have already advanced to insulin, then the weight gain associated with a necessary medication must be overcome as well. So, lifestyle, eating habits, medications, and comorbidities, must all be manipulated and eventually balanced to achieve weight control.