The role of sugars, in particular in the form of soft drinks, in the development of obesity and its metabolic and cardiovascular comorbidities is increasingly recognized. The mechanisms involved are probably multiple, but the energy content, the glycemic load and the liquid consistence play probably a more important role than the fructose content. The present recommendations encourage to limit the amount of added or free sugars to 10% maybe 5% of the daily energy intake. The replacement of sugars with sweeteners may be helpful. On a broader scale, education to a less intensely sweet taste is paramount.
In diabetic patients, lipid-lowering drug therapy is almost always necessary, even when the lipid profile is seemingly unremarkable. This treatment is primarily aimed at reaching the target LDL cholesterol level (<70 mg/dL or <100 mg/dL, depending on prior cardiac or renal diseases, age, or concomitant risk factors) by prescribing a statin, with or without ezetimibe. Thereafter, adding a fibrate or including omega-3 fatty acid supplementation should be considered in patients whose triglyceride levels remain high, so as to target non-HDL cholesterol (<100 mg/dL or <130 mg/dL, depending on age or concomitant risk factors).
The assessment of the "diabetic health" of an individual includes: (i) contemporary and secular values of HbA1c; (ii) occurrence of hypoglycemia; (iii) time spent in the glucose target range; (iv) history of ketoacidosis; (v) history of severe hypoglycemia; (vi) presence or risk of incident micro/macrovascular complications; (vii) associated cardiometabolic comorbidities; (viii) psychological issues (anxiety/depression); and (ix) occupational issues.
Obesity and Type 2 diabetes are both associated with low-grade inflammation. Among the possible pathomechanisms, their link to intestinal bacteria is becoming increasingly convincing. Evidence suggests that gut microbiota plays a key role in triggering inflammation and insulin resistance through various mechanisms, such as the translocation of bacteria or bacterial components that induces metabolic endotoxemia. Certain intestinal bacteria may also be either deleterious or beneficial to glucose homeostasis. Among these, the specific role of Akkermansia muciniphila is currently being investigated.