The 2013 American Heart Association/American College of Cardiology/The Obesity Society Guideline for the Management of Overweight and Obesity in Adults What Is New About Diet, Drugs, and Surgery for Obesity?
The 2013 American Heart Association/American College of Cardiology/The Obesity Society Guideline for the Management of Overweight and Obesity in Adults What Is New About Diet, Drugs, and Surgery for Obesity?
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DOI：
10.1161/circulationaha.114.010772
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发表时间：
2015-10-20
期刊：
影响因子：
37.8
通讯作者：
Aronne, Louis J.
中科院分区：
文献类型：
--
作者：
Apovian, Caroline M.;Aronne, Louis J.
与患者讨论Apovian和Aronne饮食、药物和肥胖手术1587。在此过程中，患者应每天检查3次手指血糖。当血糖降至100 mg/dL时，应减少药物治疗以防止低血糖。这些变化可以通过咨询内分泌学家或肥胖医学专家来促进。然而，减量方案的一个例子是将药物剂量减半或减少三分之一，每次1种药物，直到每种药物停止。在这个病人的清单中，第一个减少的药物是胰岛素，因为它是一种注射剂，对病人的吸引力最小。根据美国临床内分泌学家协会指南，在剂量下调期间，二甲双胍可最大化至1000 mg，每日两次，并可添加胰高血糖素样肽-1激动剂，如利拉鲁肽或艾塞那肽。6卡格列净或达格列净，钠-葡萄糖协同转运蛋白-2抑制剂，也可以考虑。所有这些药物都与体重减轻有关，同时改善血糖和血红蛋白A1c。提供者应建议患者继续降低导致体重增加的降糖药物的剂量，直到大部分或全部基于体重减轻期间的血糖值停止。如果2型糖尿病已经存在超过几年，糖尿病的严重程度很高，或者两者都发生，可能无法停止所有降糖药物。血糖值将指导提供者和患者。如果可能的话，这位患者也应该停用阿替洛尔，用另一种药物替代，如噻嗪类利尿剂、血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。β受体阻滞剂可能导致体重增加，不应被视为肥胖和2型糖尿病背景下高血压的一线药物。如果减肥平台以下这些变化，肥胖
Apovian and Aronne Diet, Drugs, and Surgery for Obesity 1587 discussed with the patient. Blood glucose fingersticks should be checked by the patient 3 times per day during this process. As blood glucose declines toward 100 mg/dL, medications should be decreased to prevent hypoglycemia. These changes can be facilitated by consultation with an endocrinologist or obesity medicine specialist. However, an example of a down titration regimen would be either halving or cutting the medication by one-third the dose, 1 medication at a time, until each medication is stopped. The first medication in this patient’s list to decrease would be the insulin, because it is an injectable agent and least appealing to patients. During down titration, metformin can be maximized to 1000 mg twice a day, and a glucagonlike peptide-1 agonist, like liraglutide or exenatide, could be added, based on American Association of Clinical Endocrinologists guidelines. 6 Canagliflozin or dapagliflozin, sodiumglucose cotransporter-2 inhibitors, can also be considered. All these drugs have been associated with weight loss while ameliorating blood glucose and hemoglobin A1c.The provider should counsel the patient to continue down titration of antihyperglycemic medications that cause weight gain until most or all have been stopped based on blood glucose values during the weight loss period. In cases where type 2 diabetes mellitus has been present for more than several years, the severity of diabetes mellitus is high, or both occur, it may not be possible to stop all hypoglycemic medications. The blood glucose values will guide the provider and the patient. This patient should also be weaned off atenolol, if possible, replacing it with another agent, such as a thiazide diuretic, angiotensin-converting enzyme inhibitor, or angiotensin receptor blockers. β-blocking agents may cause weight gain and should not be considered first-line agents for hypertension in the setting of obesity and type 2 diabetes mellitus. Should weight loss plateau following these changes, obesity