Insulin-associated weight gain in obese type 2 diabetes mellitus patients: What can be done?

Adrian Brown, Nicola Guess, Anne Dornhorst, Shahrad Taheri, Gary Frost

Research output: Contribution to journalReview articlepeer-review

25 Citations (Scopus)

Abstract

Insulin therapy (IT) is initiated for patients with type 2 diabetes mellitus when glycaemic targets are not met with diet and other hypoglycaemic agents. The initiation of IT improves glycaemic control and reduces the risk of microvascular complications. There is, however, an associated weight gain following IT, which may adversely affect diabetic and cardiovascular morbidity and mortality. A 3 to 9 kg insulin-associated weight gain (IAWG) is reported to occur in the first year of initiating IT, predominantly caused by adipose tissue. The potential causes for this weight gain include an increase in energy intake linked to a fear of hypoglycaemia, a reduction in glycosuria, catch-up weight, and central effects on weight and appetite regulation. Patients with type 2 diabetes who are receiving IT often have multiple co-morbidities, including obesity, that are exacerbated by weight gain, making the management of their diabetes and obesity challenging. There are several treatment strategies for patients with type 2 diabetes, who require IT, that attenuate weight gain, help improve glycaemic control, and help promote body weight homeostasis. This review addresses the effects of insulin initiation and intensification on IAWG, and explores its potential underlying mechanisms, the predictors for this weight gain, and the available treatment options for managing and limiting weight gain.

Original languageEnglish
Pages (from-to)1655-1668
Number of pages14
JournalDiabetes, Obesity and Metabolism
Volume19
Issue number12
DOIs
Publication statusPublished - 1 Dec 2017

Keywords

  • insulin therapy
  • insulin-associated weight gain
  • mechanisms
  • obesity
  • predictors
  • type 2 diabetes
  • weight loss interventions

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