Medical Experts Evaluate a Paradigm Shift in the Treatment of Type 2 Diabetes that Focuses on Weight Loss

After reviewing the current literature, an international team of specialists from four renowned diabetes research facilities, including UT Southwestern Medical Center, has recommended a key change in Type 2 diabetes treatment, focusing on obesity first and glucose control second.

Type 2 diabetes is a condition in which the levels of blood glucose (also known as blood sugar) are abnormally high. Your main source of energy is glucose. It is derived from the meals you consume.

Insulin is a hormone that helps glucose enter your cells and provide energy. If you have diabetes, your body either does not produce enough insulin or does not use it properly. As a result, the glucose in your blood stays in your bloodstream, and not enough enters your cells.

“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.

According to the researchers, losing 15 percent or more of one’s body weight can have a disease-modifying effect in Type 2 diabetes, an outcome that no other glucose-lowering intervention can achieve.

For the most effective long-term weight management, a constant weight loss of 1 to 2 pounds per week is advised. Not all diets, however, have this impact. Low-carbohydrate, low-calorie diets are beneficial for weight loss and may be easier to follow than other diets.

They point out that the new focus would necessitate updating current treatment guidelines as well as extensive provider education. The panel’s recommendations were delivered at the European Association for the Study of Diabetes meeting and were published in The Lancet.

The current diabetes treatment strategy is based on clinical studies from the 1980s that demonstrated that reducing blood sugar leads to fewer diabetes complications. According to Dr. Lingvay, these preliminary findings justify treating blood glucose as the primary aim.

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.

Ildiko Lingvay

Many persons with type 2 diabetes show no signs or symptoms. If you do have them, the symptoms will appear gradually over time. Type 2 diabetes treatment entails keeping track of your blood sugar levels. Living a healthy lifestyle allows many people to do so.

“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 discovery is part of Dr. Lingvay’s long-term research into the best ways to deliver the most effective clinical treatment to Type 2 diabetes patients. Dr. Lingvay joined UT Southwestern’s first class of Clinical & Translational Research Scholars in 2005 as an early-career faculty member.

The program is a rigorous multi-year program 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 earn a Career Development Award from the National Institutes of Health to research the function of pancreatic triglyceride buildup in beta-cell failure and Type 2 diabetes.

Type 2 diabetes is a progressive condition caused by obesity or metabolic abnormalities, according to the American Diabetes Association. Diabetes affects more than 10% of the population in the United States, with 1.5 million new cases diagnosed each year.

Patients with obesity may benefit from bariatric surgery, however, not all patients have this choice.

“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 emphasized the necessity of campaigning for insurance coverage that covers obesity and diabetes treatment, as well as working in public health to improve access to care and eliminate disparities.