US Pharm. 2021;46(11):1.

An international panel of experts from four renowned diabetes research centers, including the University of Texas (UT) Southwestern Medical Center, is recommending a pivotal change in treatment of type 2 diabetes to focus on obesity first and glucose control second.

“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, MD, MPH, MSCS, professor of internal medicine and population and data sciences at UT Southwestern.

The researchers state that dropping 15% or more of body weight can have a disease-modifying effect in type 2 diabetes, an outcome that is unattainable by any other glucose-lowering intervention. The new focus would require updating current treatment guidelines and providing significant provider education, they note. The panel’s recommendations are published in The Lancet and were presented at the European Association for the Study of Diabetes conference.

The current approach to diabetes treatment relies on clinical studies from the 1980s, which found that lowering blood sugar results in fewer complications from the disease. These early results supported treating blood glucose as the key target, said Dr. Lingvay.

“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 a 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.”

According to the American Diabetes Association, type 2 diabetes is a progressive disease caused by obesity or by abnormalities in metabolism. More than 10% of the U.S. population has been diagnosed with diabetes.

Bariatric surgery can be effective for patients with obesity, but not all patients have access to this option. “It’s hard to achieve sustained weight loss. Most lifestyle interventions result in progressive weight loss over 6 months, followed by a plateau and weight regain over 1 to 3 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.”

In line with this theme, an article in this issue by Brooke Barlow, PharmD, and Ashley Barlow, PharmD, titled, “Management of Obesity in Patients With Diabetes,” (page 31) delves further into the impact of weight on diabetes. Pharmacists, they note, play an essential role in optimizing treatment plans for patients with diabetes and comorbid obesity. The authors recommend a comprehensive review of a patient’s medications to assess potential agents—such as antipsychotics, insulin, and corticosteroids—that can contribute to weight gain.

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