Paradigm shift in treatment of type 2 diabetes to focus on weight loss

UT Southwestern Medical Center

An international panel of experts from four renowned diabetes research centers, including UT Southwestern Medical Center, has reviewed current literature and is recommending a pivotal change in treatment of Type 2 diabetes to focus on obesity first and glucose control second.

“It’s known that obesity contributes to the progression of diabetes. 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,” said first author Ildiko Lingvay, M.D., M.P.H., M.S.C.S., Professor of Internal Medicine and Population and Data Sciences at UT Southwestern, ranked as one of the nation’s top 25 hospitals for diabetes and endocrinology care.

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. 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 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, said Dr. Lingvay.

“The problem with this approach is that it doesn’t address the core problem and does not offer an opportunity to reverse the disease,” said Dr. Lingvay, who leads an active clinical research program in the Division of Endocrinology at UT Southwestern. “We propose using a proactive approach. Let’s address the cause of the disease — obesity.”

This latest finding continues Dr. Lingvay’s careerlong effort to investigate the best means to provide the most effective clinical care to patients with Type 2 diabetes. As an early-career faculty member in 2005, Dr. Lingvay participated in UT Southwestern’s first class of the Clinical & Translational Research Scholars Program, a rigorous multiyear program designed for clinical research fellows and junior faculty who are on track to obtain extramural grant funding and who show great promise toward becoming independently funded investigators. She went on to receive a National Institutes of Health Career Development Award to study the role of pancreatic triglyceride accumulation in beta-cell failure and Type 2 diabetes.

According to the American Diabetes Association, Type 2 diabetes is a progressive disease caused by obesity or by abnormalities in metabolism. More than 10% of the U.S. population has been diagnosed with diabetes, and 1.5 million more are diagnosed each year.

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,” added Dr. Lingvay. “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.

The authors’ disclosures are listed in the manuscript.

Journal Reference:

1. Ildiko Lingvay, Priya Sumithran, Ricardo V Cohen, Carel W le Roux. Obesity management as a primary treatment goal for type 2 diabetes: time to reframe the conversation. The Lancet, 2021; DOI: 1016/S0140-6736(21)01919-X