Introduction
Obesity is the leading risk factor for type 2 diabetes mellitus (DM). Regardless of the medical diabetes treatment suggested to the patient when diagnosed, lifestyle change should be the first step of treatment. In this study, it is aimed to emphasize once again the importance of lifestyle change in the treatment of diabetes by addressing a case who was diagnosed with type 2 DM at the admission to the obesity outpatient clinic, who did not have a diabetes clinic in drug-free follow-up after a 25% weight loss with lifestyle change and medication.
Case Report
A 34-year-old male patient applied to the obesity outpatient clinic for the first time in February 2016. The patient was a high school graduate, working in the textile industry, and was married. His childhood weight was normal; she started to gain weight after marriage and reached his highest weight in the last 5 years. He applied to our outpatient clinic because he was at the highest weight in his life and started to have difficulty in movements. His medical history was unremarkable except for tonsillectomy operation. He did not have a diagnosis or a history of drug use that could cause weight gain. He had never attempted to lose weight before. In his family history, there was obesity and type 2 DM in the mother. He did not smoke or drink alcohol.
Eating habits: He ate 3 main meals a day, but his biggest meal was dinner. He continued to eat every night at home until he fell asleep, and during daylight hours at work, between meals, and these were usually simple carbohydrates (such as wafers, sweets, cakes, biscuits). There were no signs of eating disorders.
Physical activity habits: He was not doing exercises. He was using public transport on his way to work and walked between transport points and home/work.
Psychological status: There were no signs of depression or mood disorder.
Motivational status: The patient wanted to voluntarily participate in a weight loss program and lose weight only for his health, he was motivated.
Physical examination: Height: 174 cm, weight: 112 kg, body mass index (BMI): 37 kg/m2, waist circumference: 116 cm, hip circumference: 120 cm. Other physical examination findings were normal except arterial blood pressure with 140/100 mmHg.
Hemogram, routine biochemistry, hemoglobinA1c (HbA1c), 2nd hour postprandial blood glucose, hormone profile, then 1 mg dexamethasone suppression test, spot urine protein/creatinine were checked, electrocardiography, echocardiography, 24-hour ambulatory blood pressure monitoring and abdominal ultrasonography were performed.
After the results were evaluated, he was diagnosed with type 2 DM, hypertension (HT) and hyperlipidemia (HL) according to current guidelines (1-3). Drug treatment was started with metformin and olmesartan/thiazide. The patient refused to receive HL therapy. Simultaneously, the patient was given medical nutrition therapy, exercise prescription, and training for behavior change.
Patient made great adjustment to recommendations and came to the doctor and dietician controls regularly. He dropped from 112 kg to 84 kg, giving a total of 28 kg in the 3-year follow-up. When he had 2nd degree obesity, BMI decreased to 28 kg/m2 and this switched him to overweight group (Table 1). HbA1c was 6.2 in May 2016 and was 5.4 in November 2016, and blood pressure was low. Drug treatments were gradually discontinued when the patient was being monitored. With continued lifestyle change, there was no increase in blood sugar (BS), A1c and blood pressure (Table 2). Scheduled last application date: July 2019 and the patient is still in the control program.
Informed consent was obtained from the patient.
Discussion
Obesity is the main determinant of poor metabolic control in type 2 diabetes. Therefore, prevention and treatment of obesity is of great importance in the management of patients with type 2 diabetes. (4)
5-10% weight loss can lower HbA1c levels, improve cardiovascular risk factors, reduce the use of antihyperglycemic, antihypertensive and lipid-lowering drugs within 1 year, and bring type 2 diabetes into remission within the first 5 years (5,6).
Many studies have shown that the combination of energy-restricted diets and exercise has an additive effect on weight loss. The beneficial metabolic effects of the Mediterranean diet have been identified and may delay the need for antihyperglycemic drug therapy in newly diagnosed type 2 diabetes patients (5,6).
In our patient, after weight loss, the amount of medication used for diabetes and HT was first reduced and then stopped without the need for medication. BS and blood pressure arterial values were normal in follow-up without medication; diabetes and HT went into remission with the continuation of lifestyle changes.
Medical nutrition therapy, physical activity and behavior change constitute the basis of obesity treatment. The first step of type 2 DM treatment is to make these changes and to provide weight loss in patients with obesity/overweight. Permanent lifestyle change is the greatest success in both diabetes and obesity treatment.
Ethics
Informed Consent: Informed consent was obtained from the patient.
Peer-review: Externally peer-reviewed.
Authorship Contributions: Surgical and Medical Practices - F.A.; Concept - F.A.; Design - F.A.; Data Collection or Processing - F.A., H.U.A.; Analysis or Interpretation - F.A., H.U.A.; Literature Search - F.A., H.U.A.; Writing - F.A., H.U.A.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study received no financial support.