Currently, the word "diet" has acquired a negative connotation and has been replaced by others such as "diet", but its clinical interpretation as caloric restriction remains the key to the initial management of type 2 diabetes (T2DM), as demonstrated by the Direct study (1), which achieved remission in 46% of T2DM cases after the first year and 36% at the end of two years, through the initial prescription of a very low calorie diet (~ 800 kcal/day). Remission, then, was between 86 % and 70 % in those patients who lost ? 15 kg. Probably the failure to get people with DT2 to lose weight is one of the major forms of therapeutic inertia, leading to unnecessary escalation of antidiabetics to the point of seeing still obese people taking insulin.
It is estimated that more than 80% of people with T2DD debut with some degree of excess weight. At that point, their identification by a muscle mass index (BMI) ? 27 kg/m² mandates a structured intervention that should include anti-obesity or preferably dual-acting drugs (also antidiabetic). Excess visceral fat (waist circumference ? 94cm or ? 90cm in men and women, respectively) indicates a high degree of insulin resistance and lends a sense of urgency to intervention (because of the cardiovascular risk involved). Although BMI does not accurately reflect fat mass, as suggested by the authors in the article included in this issue (2), it is sufficient for clinical decision making. A method such as bioimpedance, with properly calibrated instruments, can be useful to assess changes in body fat with different interventions and to better understand their mechanisms of action.
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