Clinical medicine (London, England)
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Obesity is a modifiable risk factor in the development of type 2 diabetes mellitus (T2DM), with the prevalence of both increasing worldwide. This trend is associated with increasing mortality, cardiovascular risk and healthcare costs. An individual's weight will be determined by complex physiological, psychological and societal factors. ⋯ Common diabetes medications may lead to weight gain whereas others (such as glucagon-like peptide-1 agonists and sodium-glucose cotransporter-2 inhibitors) support weight loss. Bariatric surgery improves obesity-related complications and all-cause mortality. Diabetes remission is possible after surgery and is recommended by National Institute for Health and Care Excellence in individuals with a body mass index of >35 kg/m2 and recent onset T2DM.
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Diabetes is the most common cause of end-stage kidney disease. Randomised controlled trials have shown a significant benefit of sodium-glucose transporter-2 inhibitors in patients with diabetic kidney disease (DKD), and guidelines now suggest these drugs should be considered in all patients with DKD irrespective of glucose control. ⋯ Management of diabetes in patients on renal replacement therapy (dialysis or transplantation) is uniquely challenging. This article outlines guidance on management of glucose in these vulnerable groups of patients.