Among overweight and obese individuals diagnosed with type 2 diabetes (T2D), the number on the bathroom scale may be more important than the glucose monitor number, according to findings reported at the 2021 virtual meeting of the European Association for the Study of Diabetes.
In a special symposium, Ildiko Lingvay, MD, of the University of Texas Southwestern Medical Center, Dallas, said the evidence of the benefits of weight loss in T2D management comes from several clinical trials, including the DiRECT trial which assessed an intensive lifestyle intervention in patients with overweight or obesity and T2D of less than 6 years’ duration and showed remission of T2D at 2 years in 70% of those who lost 15 kg (33 pounds) or more with an average baseline weight of 100kg (220 pounds).
Studies of bariatric surgery have also shown both immediate and sustained benefits to patients with T2D and obesity—reducing the need for glucose lowering drugs within days of surgery and improving multiple indicators of health for the long-term, Lingvay said in her presentation. The symposium reports were published online simultaneously in The Lancet. The publication was a co-sponsor of the symposium.
“Obesity is now recognized as a disease that is associated with serious morbidity and increased mortality,” she said. “One of its main metabolic complications is type 2 diabetes, as the two conditions share key pathophysiological mechanisms.
“Weight loss is known to reverse the underlying metabolic abnormalities of type 2 diabetes and, as such, improve glucose control; loss of 15% or more of body weight can have a disease-modifying effect in people with type 2 diabetes, an outcome that is not attainable by any other glucose-lowering intervention,” she noted.
“We propose that for most patients with type 2 diabetes without cardiovascular disease, the main treatment focus should be managing the key underlying abnormality and driver of the disease: obesity,” said Lingvay.
“Such an approach would have the added benefit of addressing not just high blood sugar, but other obesity-related complications, such as fatty liver, obstructive sleep apnea, osteoarthritis, high blood pressure and an elevated blood fats profile, thus having a much greater impact on the person’s overall health than just managing blood sugar alone,” she said.
Co-author, and a second presenter at the symposium, Priya Sumithran, MD, of the University of Melbourne, Australia, added, “Treatment of obesity to achieve sustained loss of 15% body weight has been shown to have a major impact on type 2 diabetes progression and even result in diabetes remission in some patients.”
Lingvay noted that bariatric surgery offers the greatest ability to achieve substantial weight loss, but while effective, it is not scalable for the vast overweight and obese populations around the world.
She noted that several pharmaceuticals are available that can help in weight loss, including orlistat, phentermine-topiramate, naltrexone-bupropion, liraglutide, and semaglutide. Lingvay also noted that other drugs such as tirzepatide had been associated with losses of 15% body weight in more than 25% of participants in clinical trials – with resultant near normalization of blood sugar control.
Most patients with T2D will have one or more features of insulin resistance, meaning their diabetes is likely driven by increasing body fat, the researchers said. “Key features that identify people in whom increasing body fat is a key mechanistic contributor to type 2 diabetes are the presence of central adiposity, increased waist circumference, multiple skin tags, high blood pressure, and fatty liver disease,” said Lingvay.
“In this population, we propose a treatment goal of total weight loss of at least 15%, with the intention of not merely improving blood sugar control, but rather as the most effective way to disrupt the core pathophysiology of type 2 diabetes and thus change its course in the long term and prevent its associated metabolic complications.”
She advocated that diabetes treatment guidelines should be updated to include substantial, sustained weight loss as a primary treatment target for patients with T2D.
In commenting on the research, Jason Halford, PhD, and president of the European Association for the Study of Obesity, told BreakingMED, “Weight is a meaningful measurement of a risk factor and something that can easily be monitored by patients. Obesity is a chronic disease in and of itself. However, for patients with pre-diabetes and full diabetes it should not be used as a proxy for glycemic control.
“Individuals’ pathways to obesity vary and treatments approaches must be personalized. Ideally, it would great to intervene before the need for surgery but often those treatment options are not available, or offered, to patients earlier on in the weight gain history,” he said. “What people living with obesity need is effective multidisciplinary treatment interventions and long-term support which can be a mixture of medical, nutritional, activity and psychology component.”
He noted that bariatric surgery can be helpful but is expensive, and some individuals regain weight after the procedure. And, he said, drugs are not a panacea: “They can be effective for many individuals and are another tool to help, but are not a substitute for comprehensive treatment approaches, and most effective when combined with these.”
Halford said that lifestyle changes are warranted, “but obesity has a biological basis which means in the current food environment, where unhealthy options are cheap, always available, highly palatable, and heavy promoted individual lifestyle changes are hard to maintain.”
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A treatment goal of 10% loss of body weight is suggested for type 2 diabetes.
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Significant body weight loss is associated with remission from diabetes.
Edward Susman, Contributing Writer, BreakingMED™
Halford disclosed no relevant relationships with industry.
Lingvay disclosed relationships with Novo Nordisk, Sanofi, Boehringer Ingelheim, Merck, Pfizer, Mylan, Eli Lilly, AstraZeneca, Janssen, Intercept, Intarcia, TARGETPharma, Mannkind, Valeritas, Bayer, and Zealand Pharma.
Sumithran disclosed relationships with Novo Nordisk.
Cat ID: 12
Topic ID: 76,12,728,791,730,12,13,413,518,669,94,918,925,159,412
