Losing 15 percent of your bodyweight may be the best treatment for diabetes

DALLAS, Texas — Diabetes and obesity often go hand-in-hand when it comes to declining health. With that in mind, a team of researchers says drastic weight loss may be the best medicine to treat and possibly cure cases of type 2 diabetes.

Study authors find that a drop in bodyweight of 15 percent should become the primary focus for patients dealing with type 2 diabetes (T2D). They add significant weight loss shows the potential to slow or even reverse the condition in many cases. Weight loss also cuts down on the medical complications which can stem from having diabetes while being overweight.

“We propose that for most patients with type 2 diabetes without cardiovascular disease, the main treatment focus should be managing the key underlying abnormality and driver of the disease: obesity,” says paper co-author Dr. Ildiko Lingvay from the University of Texas Southwestern Medical Center in a media release.

“Such an approach would have the added benefit of addressing not just high blood sugar, but other obesity-related complications, such as fatty liver, obstructive sleep apnea, 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.”

The new findings come from several sources, including the DiRECT trial which examined how intensive lifestyle interventions benefited patients who were overweight or obese and had T2D for less than six years. The results of that study revealed that seven in 10 patients who lost an average of 15 percent of their bodyweight experienced a remission of their diabetes within two years. Studies of bariatric weight loss surgery also showed that the procedure results in sustained and immediate health benefits for T2D patients.

Weight loss drugs can also help reverse diabetes

Along with dieting and weight loss surgery, the international team finds several drugs can also help overweight diabetes patients shed excess pounds. The review names five drugs in particular which have received approval from at least one regulatory authority worldwide. These include orlistat, phentermine–topiramate, naltrexone–bupropion, liraglutide 3.0 mg, and semaglutide 2.4 mg.

In the United States, the U.S. Food and Drug Administration approved semaglutide for use as a weight management drug in June of 2021. Researchers note that other drugs, such as tirzepatide, are also in development and show promise as a weight loss medication.

Previous studies on semaglutide and tirzepatide have demonstrated that over a quarter of diabetes patients using these drugs have lost the recommended 15 percent of their weight. Moreover, these patients saw their blood sugar control normalize after this weight loss.

Obesity is the key driver of diabetes in most patients

Study authors note that 40 to 70 percent of type 2 diabetes patients experience one or more features of insulin resistance. This means their condition is likely a result of increasing body fat.

“Key features that identify people in whom increasing body fat is a key mechanistic contributor to type 2 diabetes are the presence of central adiposity (fat around the waist), increased waist circumference, multiple skin tags, high blood pressure, and fatty liver disease,” explains Dr. Lingvay. “In this population, we propose a treatment goal of total weight loss of at least 15%, with the intention of not merely improving blood sugar control, but rather as the most effective way to disrupt the core pathophysiology of type 2 diabetes and thus change its course in the long term and prevent its associated metabolic complications.”

Due to these findings, the team says it’s time to redefine the goals for treating diabetes. First, they believe treatment guidelines should shift their focus from managing diabetes to sustaining significant weight loss among T2D patients.

“Also vital is that medical practice management should refocus to effectively incorporate weight management for patients with type 2 diabetes,“ adds Dr. Lingvay. “Health-care providers, especially those managing people with diabetes routinely, should be trained and become experienced in all aspects of obesity management.”

“The time is right to consider the addition of substantial weight loss as a principal target for the treatment of many patients with type 2 diabetes,” the team concludes.

Researchers presented their findings at the Annual Meeting of the European Association for the Study of Diabetes.

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