An obesity specialist explains why clinicians should start at the root cause when managing patients with type 2 diabetes and obesity.
Historically, the treatment of patients with diabetes and obesity has focused on glucose control and cardiovascular risk reduction. While much depends on the patient’s individual health profile, treating obesity first means addressing diabetes at its root cause. American Diabetes Awareness Month may be behind us now, but it is never too late to start a conversation with patients who have type 2 diabetes (T2D) and obesity about treatment approaches.
T2D typically begins with insulin resistance. Early laboratory markers of insulin resistance can include elevated fasting glucose, elevated fasting insulin, high triglycerides, and low high-density lipoprotein (HDL) cholesterol. When left untreated or unmanaged, insulin resistance will progress to prediabetes and eventually meet the criteria for diabetes.
Insulin resistance happens for a variety of reasons, including genetics, lifestyle, increased emotional stress, and underlying health conditions, such as obesity. When the body develops insulin resistance, it struggles to maintain an appropriate blood sugar level by increasing insulin levels, which can lead to weight gain. Because of the critical roles that insulin and insulin resistance play in regulating blood sugar, individuals with obesity are 6-times more likely to develop T2D.
Even a small amount of weight loss can have a monumental impact on a patient’s risk for prediabetes and T2D. The US Centers for Disease Control and Prevention’s Diabetes Prevention Program showed that 7% weight loss reduced the risk of progressing from prediabetes to T2D by 58%.
The focus of diabetes management is often glucose control, but T2D is so much more than abnormal glucose – it is a total body disease, much like obesity. Diabetes is a metabolic disease with lipid dysfunction, proinflammatory cytokines, and a prothrombic state that further contributes to cardiovascular disease.
A recent study found that 61% of patients who participated in a yearlong lifestyle modification program focused on a low-calorie diet and physical activity experienced T2D remission. Treating obesity reduces adipose tissue in the body, particularly visceral adipose tissue, which reduces insulin resistance and allows endogenous insulin to better control blood glucose.
Every patient is different, and so is their medication protocol, but broadly speaking, for patients on insulin or sulfonylureas, reducing insulin resistance through weight loss can lessen medication requirements. In addition, lowering the dosage or completely stopping these medications can facilitate additional weight loss.
By addressing obesity first in the setting of T2D, clinicians and patients can reduce, or even prevent, insulin resistance. T2D is decades in the making, as it begins to develop long before glucose rises. Studies have shown that insulin resistance can precede T2D by 10 to 15 years. Helping a patient achieve and maintain a healthy weight can reduce insulin resistance and protect pancreatic beta cell health.
By leveraging a combination of a healthy diet, regular physical activity effective behavioral health strategies, and appropriate medications, physicians and patients can realize the long-term benefits of treating obesity first in synergy with diabetes treatment, rather than attempting to patch together treatments for one condition or the other.
For more information on treating obesity and diabetes plus exclusive access to resources and a network of obesity medicine providers, join the Obesity Medicine Association (OMA). OMA is the largest clinical obesity organization in the US and provides advanced resources to support providers as they implement evidence-based treatment in their practices.