Obesity in type 2 diabetes: Recommendations from guidelines are largely consistent

July 30, 2012

On 10th July 2012, the German Institute for Quality and Efficiency in Health Care (IQWiG) published the results of a literature search for evidence-based guidelines for the treatment of obesity in type 2 diabetes. The aim of the report was to identify those recommendations from current guidelines of high methodological quality that may be relevant for a possible new obesity module in the disease management programme (DMP) for type 2 diabetes.

Diet, exercise and behavioural therapy generally advised

IQWiG found that the recommendations of the various guidelines for the treatment of people with who are also grossly overweight were more or less consistent: in general, alongside weight reduction, diet, exercise and behavioural therapy were also advised. Above a certain (BMI), some guidelines also mention drugs to aid weight reduction (BMI ≥ 27 kg/m²) or surgery - for example a gastric bypass (BMI ≥ 35 kg/m²) - as a treatment option. However, the strength of the recommendation, i.e. whether the particular intervention "could", "should" or "must" be used, varies between the individual guidelines. The level of evidence, i.e. the extent to which the recommendations are backed up by results from studies, also differs.

Systematic reviews do not report patient-relevant outcomes

In accordance with the commission received from the Federal Joint Committee (G-BA), the Institute searched for and evaluated systematic reviews, as well as guidelines. The aim was to compare the recommendations of the guidelines with the conclusions of the reviews, i.e. the scientific evidence from studies. However, IQWiG was unable to identify any reviews that were based on the results of studies of high and summarized the relevant results for the treatment of people who suffered from both type 2 and obesity.

Furthermore, the systematic reviews reported largely metabolic parameters, but no patient-relevant outcomes such as blindness or amputation. This means that the conclusions in the guidelines are, for the most part, not supported by evidence from systematic reviews.

Procedure of report production

IQWiG published the preliminary results in the form of the preliminary report in October 2011 and interested parties were invited to submit comments. When the commenting procedure ended, the preliminary report was revised and sent as a final report to the contracting agency, the Federal Joint Committee, in May 2012. The written comments are published in a separate document at the same time as the final report. The report was produced in collaboration with external experts.

On 10th July 2012, the German Institute for Quality and Efficiency in (IQWiG) published the results of a literature search for evidence-based guidelines for the treatment of obesity in type 2 diabetes. The aim of the report was to identify those recommendations from current guidelines of high methodological quality that may be relevant for a possible new obesity module in the disease management programme (DMP) for type 2 diabetes.

Diet, exercise and behavioural therapy generally advised

IQWiG found that the recommendations of the various guidelines for the treatment of people with type 2 diabetes who are also grossly overweight were more or less consistent: in general, alongside weight reduction, diet, exercise and behavioural therapy were also advised. Above a certain Body Mass Index (BMI), some guidelines also mention drugs to aid (BMI ≥ 27 kg/m²) or surgery - for example a gastric bypass (BMI ≥ 35 kg/m²) - as a treatment option. However, the strength of the recommendation, i.e. whether the particular intervention "could", "should" or "must" be used, varies between the individual guidelines. The level of evidence, i.e. the extent to which the recommendations are backed up by results from studies, also differs.

Systematic reviews do not report patient-relevant outcomes

In accordance with the commission received from the Federal Joint Committee (G-BA), the Institute searched for and evaluated systematic reviews, as well as guidelines. The aim was to compare the recommendations of the guidelines with the conclusions of the reviews, i.e. the scientific evidence from studies. However, IQWiG was unable to identify any reviews that were based on the results of studies of high methodological quality and summarized the relevant results for the treatment of people who suffered from both type 2 diabetes and obesity.

Furthermore, the systematic reviews reported largely metabolic parameters, but no patient-relevant outcomes such as blindness or amputation. This means that the conclusions in the are, for the most part, not supported by evidence from systematic reviews.

Procedure of report production

IQWiG published the preliminary results in the form of the preliminary report in October 2011 and interested parties were invited to submit comments. When the commenting procedure ended, the preliminary report was revised and sent as a final report to the contracting agency, the Federal Joint Committee, in May 2012. The written comments are published in a separate document at the same time as the final report. The was produced in collaboration with external experts.

Explore further: DMP for diabetes type 2: Current guidelines indicate some need for revision

More information: The following executive summary ( www.iqwig.de/download/V09-02_E … _type_2_diabetes.pdf ) provides an overview of the background, methods and further results of the final report.

Related Stories

DMP for diabetes type 2: Current guidelines indicate some need for revision

January 3, 2012
On 3 January 2012, the German Institute for Quality and Efficiency in Health Care (IQWiG) published the results of a literature search for evidence-based clinical practice guidelines on the treatment of people with diabetes ...

Guidelines on rare diseases: Methods on handling evidence neither identified nor required

April 28, 2011
People with rare diseases have the same right to high-quality health care in line with current medical knowledge as other patients do. However, relevant and reliable clinical studies on rare diseases are often lacking. Among ...

Elevated cholesterol levels: Benefit of ezetimibe is not proven

September 14, 2011
Elevated blood cholesterol levels are regarded as a risk factor for heart attacks and other cardiovascular diseases. However, this does not necessarily mean that every cholesterol-lowering drug can also prevent heart attacks. ...

Benefit of blood glucose lowering to near-normal levels remains unclear

July 14, 2011
Whether patients with type 2 diabetes mellitus benefit from attempts to lower their blood glucose levels to near-normal levels through treatment ("intensive blood glucose control") remains an unanswered question. The studies ...

Recommended for you

Diabetes can be tracked with our Google searches

July 26, 2017
The emergence of Type 2 Diabetes could be more effectively monitored using our Google searches—helping public health officials keep track of the disease and halt its spread—according to research by the University of Warwick.

Scientists discover a new way to treat type 2 diabetes

July 21, 2017
Medication currently being used to treat obesity is also proving to have significant health benefits for patients with type 2 diabetes. A new study published today in Molecular Metabolism explains how this therapeutic benefit ...

Alzheimer's drug cuts hallmark inflammation related to metabolic syndrome by 25 percent

July 20, 2017
An existing Alzheimer's medication slashes inflammation and insulin resistance in patients with metabolic syndrome, a potential therapeutic intervention for a highly dangerous condition affecting 30 percent of adults in the ...

Diabetes or its precursor affects 100 million Americans

July 19, 2017
Almost one-third of the US population—100 million people—either has diabetes or its precursor condition, known as pre-diabetes, said a government report Tuesday.

One virus may protect against type 1 diabetes, others may increase risk

July 11, 2017
Doctors can't predict who will develop type 1 diabetes, a chronic autoimmune disease in which the immune system destroys the cells needed to control blood-sugar levels, requiring daily insulin injections and continual monitoring.

Diabetes complications are a risk factor for repeat hospitalizations, study shows

July 7, 2017
For patients with diabetes, one reason for hospitalization and unplanned hospital readmission is severe dysglycemia (uncontrolled hyperglycemia - high blood sugar, or hypoglycemia - low blood sugar), says new research published ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.