“The time is right to consider the addition of substantial (ie, double-digit %) weight loss as a principal target for the treatment of many patients with type 2 diabetes,” the paper reads, recommending that the approach would effectively address the pathophysiology of the disease.
According to Diabetes Australia, the chronic condition is one of the fastest growing in the country and affects 1.7 million people, with an annual cost of about $14.6 billion. About 280 people are diagnosed with the condition every day — or one person every five minutes.
Depending on how advanced the condition is, it can initially be treated with healthy eating and regular physical activity but people with type 2 diabetes may be required to take tablets or insulin over time.
One of the study authors, endocrinologist and clinician researcher Dr Priya Sumithran said that evidence of the benefits of weight loss management for people living with type 2 diabetes (the most common form of the disease developed in later life), and in some cases full remission, was supported by several sources.
“Treatment of obesity to achieve sustained loss of 15% body weight has been shown to have a major impact on type 2 diabetes progression and even result in diabetes remission in some patients,” Sumithran said.
In one study, known as the DiRECT trial, type 2 diabetes patients were assessed while they participated in an intensive lifestyle intervention. In the trial, 70% of overweight subjects (with an average baseline weight of 100 kilograms) who had type 2 diabetes for less than six years were able to reverse the effects of the condition.
The paper also considered studies of bariatric surgery, which showed immediate and sustained benefits of weight loss to type 2 diabetes. This study found that after bariatric surgery, people living with diabetes had a reduced need for glucose lowering drugs within days. Multiple health indicators also improved for these patients in the long term.
Dr Ildiko Lingvay from the University of Texas Southwestern Medical Centre, a co-author of the paper, said that obesity was a ‘key underlying abnormality’ driving type 2 diabetes.
Lingvay said that if weight management was used as the main treatment for high blood sugar patients who did not have cardiovascular disease, it would also address other obesity-related complications.
“Such an approach would have the added benefit of addressing fatty liver, obstructive sleep apnoea, osteoarthritis, high blood pressure and an elevated blood fats profile, thus having a much greater impact on the person’s overall health than just managing blood sugar alone,” Lingvay said.
One in two people with diabetes in Australia will develop chronic kidney disease, and 28% of people living with diabetes are more likely than those who do not have the condition to die of heart failure.
The Lancet paper was presented in October at the Annual Meeting of the European Association for the Study of Diabetes (EASD). The authors told the conference that sustained weight loss was an important consideration for redefining patient treatment goals, and that treatment guidelines should be updated to reflect this.
health systems should also focus on upstream benefits of reducing obesity in preventing or controlling type 2 diabetes, the authors said, in a bid to avoid the more costly treatment of patients with advanced diabetes, and the ‘cluster of complications that can come with the condition’.
“health-care providers, especially those managing people with diabetes routinely, should be trained and become experienced in all aspects of obesity management,” Dr Lingvay said.
“Support staff should be trained to support patients through their weight-loss journeys, and practices should consider the need for specialised staff to deliver the educational component of the new treatment strategies that are proposed.”