An international panel of experts from four renowned diabetes research centres has reviewed current literature and has recommended a pivotal change in treatment of Type 2 diabetes - to focus on obesity first and glucose control second. The researchers state that dropping 15% or more of body weight can have a disease-modifying effect in Type 2 diabetes, an outcome that is unattainable by any other glucose-lowering intervention.
"It's known that obesity contributes to the progression of diabetes,” said first author, Dr Ildiko Lingvay, Professor of Internal Medicine and Population and Data Sciences at UT Southwestern “What's new is that instead of focusing exclusively on lowering blood sugar, we recommend the primary approach to the treatment of Type 2 diabetes be on the treatment of obesity.”
The new focus would require updating current treatment guidelines and providing significant provider education, they note. The panel's recommendations are published in The Lancet, ‘Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation’, and were presented at the European Association for the Study of Diabetes conference.
The current approach to diabetes treatment relies on clinical studies from the 1980s, which found that lowering blood sugar results in fewer complications from the disease. These early results supported treating blood glucose as the key target, explained Lingvay, who leads an active clinical research programme in the Division of Endocrinology at UT Southwestern.
"The problem with this approach is that it doesn't address the core problem and does not offer an opportunity to reverse the disease," she added, "We propose using a proactive approach. Let's address the cause of the disease - obesity."
Bariatric surgery can be effective for patients with obesity, but not all patients have access to this option.
"It's hard to achieve sustained weight loss. Most lifestyle interventions result in progressive weight loss over six months, followed by a plateau and weight regain over one to three years. New weight loss medications and those in the pipeline will help patients succeed in managing their weight over the long term."
The researchers also stressed the importance of advocating for insurance coverage that supports treatment of obesity and diabetes, and working in public health to increase access to care and reduce disparities.