Researchers support the role of weight loss in the management of type 2 diabetes and “discuss the logistical challenges to implementing a new weight-centric primary treatment goal in people with type 2 diabetes,” in a review in The Lancet. 

Sustained weight loss of at least 15% bodyweight has a major effect on the progression of type 2 diabetes, according to previous research. 

“Our proposed therapeutic framework intends to harness weight loss as a disease-modifying intervention for people with type 2 diabetes who are identified as having an adiposity-based chronic   disease that is complicated by hyperglycemia. We term this framework to be weight-centric to acknowledge that weight loss is the most common and effective means to reverse adipose pathology,” Ildiko Lingvay, MD, Division of Endocrinology, Department of Internal Medicine and Dept. of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, and colleagues wrote. 

Lingvay and researchers added that the underlying metabolic abnormalities are usually present decades before a diagnosis. 

Weight loss can create ideal conditions for weight regain in the long term, such as a greater desire to eat. Variability in individual weight loss outcomes is another big challenge, they wrote. 

Bariatric surgery is an established treatment for people with type 2 diabetes. 

In a 12-year follow-up, participants who underwent gastric bypass had a 27% total weight loss and lower incidence of type 2 diabetes compared to a non-surgical treatment group. 

Five pharmacotherapy agents are approved by one or more regulatory authorities worldwide for chronic weight management: orlistat, phentermine-topiramate, naltrexone-bupropion, liraglutide and semaglutide. In addition to phentermine in the short term. 

Treatment guidelines need to be updated to include recent evidence for remission of type 2 diabetes after weight loss but also focus on sustained weight loss as a “primary treatment target” for patients with type 2 diabetes, they wrote. 

“With the promise of new options, it is time to consider shifting the treatment focus for patients with type 2 diabetes from the current reactive glucocentric approach to addressing obesity, the core driver of insulin resistance and contributor to β-cell failure,” Lingvay and colleagues wrote.

“In the same manner that addition of cardiovascular risk reduction as a central goal for patients with type 2 diabetes and established cardiovascular or renal disease did not replace the need to optimize glycemic control, it is important to stress that a new weight-centric goal would not exclude the parallel goal of glycemic control nor replace other evidence-based strategies for decreasing the risk of microvascular and macrovascular complications of type 2 diabetes.” 


Reference: 
Lingvay I, et al. The Lancet. https://doi.org/10.1016/S0140-6736(21)01919-X 

Disclosures: Authors declared financial ties to drugmakers. See full study for details. 
Images: Getty Images, Pixabay 


By MD /alert Staff