Losing weight, no matter how much or how little, has health benefits for obese people with type 2 diabetes. And the more they lose, the better the outcome, said Priya Sumithran, PhD, Senior Research Fellow, Faculty of Medicine, Dentistry, and Health Sciences at the University of Melbourne, Australia.
Dr. Sumithran was one of three panelists in the Scientific Sessions symposium Obesity Management as a Primary Treatment Goal for Type 2 Diabetes—It’s Time for a Paradigm Shift. The session was originally presented Sunday, June 5, and can be viewed on-demand by registered meeting participants at ADA2022.org. If you haven’t registered for the 82nd Scientific Sessions, register today to access the valuable meeting content.
Obesity is linked with pathophysiological drivers of type 2 diabetes, said Dr. Sumithran. It causes beta-cell dysfunction and insulin resistance but, depending on the stage of the diabetes, that dysfunction and resistance can be improved if the patient loses weight.
Patients with type 2 diabetes have experienced health benefits after as little as 3% weight loss, she noted. With enough weight loss, some patients go into remission. And it doesn’t matter how the weight is lost—be it through lifestyle intervention, bariatric surgery, or medication.
Dr. Sumithran cited a study of 300 people with type 2 diabetes who were counseled to make healthy lifestyle changes that would promote weight loss. In the study, 24% of the participants lost significant amounts of weight, and nearly half of those achieved remission of diabetes at the end of one year.
“The numbers are lower at the second year, but nonetheless this study showed that intensive lifestyle intervention can achieve a mean weight loss of around 10% at one year and remission of diabetes in more than a third of people at two years in a group of people with a relatively recent onset of diabetes,” she said.
The duration of diabetes is strongly associated with the likelihood of remission, Dr. Sumithran noted, but even people with long-standing diabetes will benefit from weight loss.
Ricardo V. Cohen, MD, a bariatric surgeon at Oswaldo Cruz German Hospital in Sao Paulo, Brazil, discussed the effectiveness of bariatric surgery in treating type 2 diabetes. A 10% reduction in weight often results in achieving A1C levels less than 6.5 in patients with type 2 diabetes, he said. But eight out of 10 patients who lose weight through lifestyle changes need additional intervention for maintenance because they tend to regain the weight, he added.
A 2020 Swedish study found that obese people who had bariatric surgery experienced a mean body mass index (BMI) reduction of approximately 11 points one year after surgery, followed by a gradual weight regain until about year eight. After that, the mean BMI stabilized at approximately 7 points less than the baseline BMI across the study.
Bariatric surgery has also been linked to remission of hypertension, lower mortality from kidney disease, and a significant decrease in nephropathy, said Dr. Cohen, adding that 34 studies have linked bariatric surgery with a decrease in all-cause mortality.
“If patients are not responding early to the best medications available or are unable to conform to whatever type of lifestyle intervention, why not metabolic and bariatric surgery?” he asked.
Ivania Rizo, DMSC, MD, Director of Obesity Medicine at Boston Medical Center, discussed the role of pharmacotherapy in treating diabetes and obesity.
Glucagon-like peptide-1 (GLP-1) receptor agonists like semaglutide and tirzepatide lower A1C levels and promote weight loss. The agents decrease appetite through the central nervous system and slow digestion, she said.
Tirzepatide, which is a novel, once-weekly, dual glucose-dependent insulinotropic polypeptide and GLP-1 receptor agonist, is the first and only diabetes drug to help patients lose more than 20% of their weight, she said.
Dr. Rizo noted that there are low adoption rates of pharmacotherapies that promote weight loss. Fewer than 2% of obese people are prescribed approved weight loss medications, she said, though the rates are much higher among patients with type 2 diabetes. This is due, in part, to the way the treatments are covered by insurance, she noted.