Obesity Management in Primary Care: A Key Strategy for Type 2 Diabetes Control
Obesity Management in Primary Care: A Key Strategy for Type 2 Diabetes Control
— By Dawn M. Sweet, Ph.D.
With effective pharmacological and lifestyle interventions for weight loss and blood glucose control, it may be time to consider obesity management as a primary treatment goal for patients with type 2 diabetes.
Obesity and type 2 diabetes mellitus are commonly paired cardiometabolic comorbidities. As such, treatment plans that manage both conditions simultaneously offer a streamlined approach. While weight is not part of the type 2 diabetes diagnostic criteria, it is a risk factor. Current thinking often focuses on preventing or treating downstream metabolic consequences rather than addressing obesity as a pathophysiological driver of type 2 diabetes.1 Working with patients to achieve a seven percent weight loss could reduce their risk of developing type 2 diabetes, with some research showing that a sustained 15 percent weight loss can lead to remission of type 2 diabetes and markedly improve metabolic status.2,3,4
Advances in pharmacological therapies like GLP-1 receptor agonist (RA) medications have now made it somewhat easier to help patients with obesity lose weight, thereby minimizing the risk of developing type 2 diabetes. For patients with type 2 diabetes and obesity, lifestyle interventions and pharmacological management represent two effective approaches. Positioning obesity management as a primary goal for treating patients with type 2 diabetes can transform the treatment and management approach.1
Lifestyle Interventions for Type 2 Diabetes
Comprehensive lifestyle changes have proven effective in achieving glycemic control and type 2 diabetes remission. For example, the DiRECT randomized controlled trial investigated intensive dietary interventions in 306 adults with type 2 diabetes (BMI 27–45 kg/m²).4 This was an open-label, cluster-randomized trial conducted at primary care practices in the U.K. Practices were randomly assigned to one of two conditions: an integrated weight management program (intervention) or a best-practice program (control). Study sites and practice sizes (< 5,700 or ≤ 5,700) were stratified as part of the randomization process. Participants were included if they were between 20 and 65 years old, had been diagnosed with type 2 diabetes for less than six years, and had not used insulin between July 2014 and August 2016.
The intervention included the withdrawal of diabetes medication, a very low calorie diet (825–853 kcal per day) for 12–20 weeks, a stepped reintroduction of food (two to eight weeks), and structured support for weight loss. After two years, 11 percent of participants in the integrated weight management group lost at least 15 kg of body weight, compared to only two percent in the control group. A post-hoc analysis revealed that 70 percent of participants who lost more than 15 kg also achieved type 2 diabetes remission, compared to 60 percent of those who lost 10–15 kg, and 29 percent of those who lost 5–10 kg. It should be noted that even participants in the intervention group who did not go into type 2 diabetes remission still reported a lower HbA1c compared to the control group.
In the Look AHEAD randomized controlled trial (N = 5,145 adults with type 2 diabetes), participants in the intensive lifestyle intervention group lost an average of 4.7 percent of their body weight after four years, compared to just 0.8 percent in the control group. However, only seven percent of participants in the lifestyle group experienced a reduction in HbA1c levels, suggesting that more substantial weight loss may be necessary to meaningfully impact glycemic control.5
Pharmacotherapy for Weight Loss and Type 2 Diabetes
GLP-1 RA medications, such as semaglutide and liraglutide, are effective weight-loss management strategies for patients with and without type 2 diabetes.6 The advent of GLP-1 RA medications has filled the treatment gap between bariatric surgery and lifestyle interventions.
Liraglutide 3.0 mg was found to result in 3.4–6.1 percent weight loss in adults without diabetes compared to a placebo. It has been reported that between 50.5 and 73 percent of non-diabetic adults lost ≥ 5 percent of their body weight. Among adults with type 2 diabetes, the average difference in weight loss between the liraglutide group and the control group was less than five percent one year after treatment.
The STEP 1-4 clinical trials demonstrated a 10.2 percent to 17.4 percent greater mean weight loss with semaglutide 2.4 mg in participants without type 2 diabetes compared to placebo. Additionally, 86.4 percent to 88.7 percent of these participants lost at least five percent of their baseline weight. In adults with type 2 diabetes, semaglutide resulted in a 6.2 percent greater weight loss compared to placebo, with 68.8 percent of participants losing at least five percent of their baseline weight.7
Practical Implications for Health Care Providers
Updating treatment plans to focus on integrating weight management for patients with type 2 diabetes aligns with current evidence suggesting that sustained double-digit weight loss and lifestyle interventions can move type 2 diabetes into remission. Healthcare providers should consider training in various aspects of obesity management, with special emphasis on weight loss. Additionally, support staff should be trained on how to help patients through their weight loss programs. Healthcare providers should discuss with their patients the importance of weight loss for managing type 2 diabetes and how lifestyle changes and pharmacotherapy could help move type 2 diabetes into remission.
Scientifically formulated meal replacements offer health care professionals a valuable nonpharmacological treatment option for patients with type 2 diabetes. These meal replacements can be used independently or in conjunction with GLP-1 therapies to enhance nutritional support, promote healthy weight loss, and help preserve muscle mass during treatment.
Source(s):
1 Obesity management as a primary treatment for type 2 diabetes: Time to reframe the conversation
2 American Diabetes Association: Understanding Diabetes Diagnosis
5 Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes
About the Author: Dr. Dawn M. Sweet has over 20 years of experience in the field of communication. Dr. Sweet has given several invited talks to and workshops for academic and private sector audiences on the role of nonverbal and verbal communication in achieving positive outcomes and mitigating bias. Her research has been published in several top ranked peer-review journals, and it has been featured on NPR’s River to River / All Things Considered, Buzzfeed, and Science Daily. Her research has also been used to inform expert testimony.
About Robard: Robard Corporation’s medical obesity treatment programs and scientifically-designed nutrition products have been utilized by physicians, surgeons and hospitals across the United States to successfully treat patients living with obesity. To learn more about us and how we can help your practice and patients, visit us online www.Robard.com, email us at info@robard.com, or call (800) 222-9201.
