The considerable commonalities between patients with obesity and Type 2 diabetes can be useful for healthcare providers as they develop treatment plans for these serious diseases. Unfortunately, the prevalence of both diseases continues to rise — the number of adults with obesity has increased by more than 200% in recent decades, more than 70% of American adults are considered overweight and American adults with obesity make up more than 40% of the population.
The risk of developing prediabetes and Type 2 diabetes increases as BMI increases. An increase in visceral adipose tissue increases diabetes risk, in part because visceral fat itself responds weakly to insulin. Less susceptible to the anti-lipolytic property of insulin than other tissues, this fat becomes a source of lipotoxic circulating free fatty acids, which in turn further reduces insulin sensitivity in muscle and liver tissue, limiting glucose disposal after meals. Another contribution of excess weight to diabetes risk is related to inflammation.
There is a powerful feedback loop at work here: overweight leads to hyperinsulinemia, which leads to further overweight, which leads to further hyperinsulinemia and insulin resistance. The scope of the problem is daunting, but the good news is that our understanding of the treatment of obesity and diabetes has been refined to a point that we may address both at once. Healthcare providers who focus on obesity treatment and arm themselves with the tools and principles of obesity medicine to prevent and care for Type 2 diabetes can help their patients lead healthier lives.
The Diabetes Prevention Program found that even a 7% decrease in body weight is associated with a 58% reduction in the risk of developing Type 2 diabetes. A weight loss of 5% to 10% improves glycemic control and a 20% weight loss can potentially reverse Type 2 diabetes. By treating diabetes with an obesity focus, clinicians can control glucose levels while also treating the underlying pathophysiology of Type 2 diabetes, insulin resistance. Thus, treating diabetes with medications that benefit weight, like metformin, GLP-1 receptor agonists, and SGLT-2 inhibitors rather than using medications that promote weight gain, like insulin and sulfonylureas, can have a dual benefit.
Bariatric Surgery and Diabetes
Bariatric surgery is most often discussed as an obesity intervention, but it benefits patients with Type 2 diabetes as well. Five-year outcomes from the STAMPEDE trial show that bariatric surgery is more effective than intensive medical therapy for controlling glucose. Surgery benefits appear to extend past caloric restriction and point to improved metabolic function. The International Diabetes Foundation also notes that surgical intervention can be a cost-effective treatment for Type 2 diabetes.
Obesity and Diabetes Resources
The Obesity Medicine Association (OMA) provides a spectrum of resources to educate healthcare providers on the connection between obesity and adiposity-related diseases like Type 2 diabetes. Designed for all healthcare providers who treat patients with obesity, the Fundamentals of Obesity Treatment Virtual Course provides introductory education about the evidence-based approaches for evaluating, diagnosing and treating obesity in a clinical setting.