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Weight-Loss Programs for People With Diabetes

by Erica Sweeney

For people with diabetes who are overweight, sustained weight loss can have many positive effects, including lower blood glucose levels, better cardiovascular health, and better sleep. While most weight-loss advice is aimed at people with Type 2 diabetes, many of whom are overweight or obese, being overweight with Type 1 diabetes carries risks, too.

No matter what type of diabetes a person has, excess weight tends to increase insulin resistance. With increased insulin resistance, more insulin or other blood-glucose-lowering medicines are needed to keep blood glucose levels in target range. Losing excess weight lowers insulin resistance and often allows a person to lower his doses of insulin or other medicines. For people with Type 2 diabetes, it may mean being able to stop insulin or other medicines altogether. (People with Type 1 diabetes always need to take some insulin, even at a healthy weight.)

While there are many approaches to losing excess weight that can be successful, weight-loss programs that use a team approach and are medically supervised can be especially effective at putting people who need to lose weight on track for success. In programs that take a team approach, endocrinologists, registered dietitians, and other people who are working to lose weight work together to form a support system and a sense of accountability during the process.

How it works
For Terry Sharp, 56, who was diagnosed with Type 2 diabetes about 20 years ago, a weight-loss program with a team approach helped him lose weight and reduce the amount of insulin he needed to take. Despite being active his whole life, Sharp’s weight was “never going down,” and his blood glucose remained high, he says. In 2010, during a routine visit to his endocrinologist, Sharp weighed in at 277 pounds and was told he needed to lose weight. “[My doctor] told me I was doing half the work,” he says, referring to his regular exercise but less-than-healthy diet. “But I was getting zero results.” So Sharp joined the University of Arkansas for Medical Sciences’ (UAMS) Weight Loss and Metabolic Control Clinic, located in Little Rock, Arkansas.

“I didn’t tell anyone at first,” Sharp says. “I was afraid I’d fail. I followed the plan, got control of my diet, and, pretty soon, I saw results.”

“Diabetes is one of the few diseases that can be managed with diet,” says Registered Dietitian Betsy Day, manager of the UAMS clinic. “But patients must be proactive.”

The clinic offers a 16-week program that incorporates meal replacements, behavior modification classes, and medical supervision, says Day. There are two endocrinologists on staff, which sets the UAMS clinic apart from other weight-loss programs and is important because people with diabetes need monitoring by medical professionals, she says.

Before beginning the program, potential participants undergo an initial evaluation, including tests of kidney and liver function, blood glucose measurements, and blood cholesterol and triglyceride measurements, Day says. The initial lab tests are repeated after the first four weeks, and routine monitoring is also conducted.

The program does not rely on weight-loss medicines, says Monica Agarwal, an endocrinologist at the UAMS clinic. Those who enroll in the program are taught to set realistic goals and encouraged to understand that lifestyle changes must be sustained to lose weight and maintain the loss, Day says.

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