Obez ve Aşırı Kilolu Hastalarda Diyabet Yönetimi
Özet
Obezite, dünya genelinde hızla artarak Tip 2 diyabet ve kardiyovasküler hastalıklar için ana risk faktörü haline gelmiştir. Tip 2 diyabetli hastaların büyük çoğunluğunun aşırı kilolu veya obez olması, glisemik kontrolü zorlaştırmakta ve mortaliteyi artırmaktadır. Bu hastaların yönetiminde yaşam tarzı değişiklikleri (Akdeniz diyeti, haftada 150 dakika egzersiz) temel esastır. Tıbbi tedavide ilk seçenek metformindir; sonraki aşamalarda kilo alımına yol açan ilaçlardan kaçınılmalı, kilo verdirici veya nötr etkili (SGLT-2 inhibitörleri, GLP-1 agonistleri) ajanlar tercih edilmelidir. İlaç dışı seçeneklerde, orlistat ve liraglutid gibi onaylı obezite ilaçları glisemik kontrolü destekler. Yaşam tarzı ve medikal tedaviye yanıt vermeyen, VKİ ≥35 kg/m² olan uygun hastalarda ise metabolik cerrahi (özellikle sleeve gastrektomi ve gastrik bypass), diyabet remisyonu ve kardiyovasküler risk azaltımında en güçlü seçenektir.
Obesity has rapidly increased worldwide, becoming a major risk factor for Type 2 diabetes and cardiovascular diseases. The fact that the vast majority of patients with Type 2 diabetes are overweight or obese complicates glycemic control and increases mortality. Lifestyle modifications (Mediterranean diet, 150 minutes of exercise per week) are essential in management. Metformin is the first choice in medical treatment; in subsequent stages, weight-gaining drugs should be avoided, and weight-reducing or neutral agents (SGLT-2 inhibitors, GLP-1 agonists) should be preferred. Approved obesity medications like orlistat and liraglutid support glycemic control. For eligible patients with a BMI ≥35 kg/m² who do not respond to lifestyle and medical therapy, metabolic surgery (especially sleeve gastrectomy and gastric bypass) is the most potent option for diabetes remission and cardiovascular risk reduction.
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