A T2D treatment approach that prioritizes weight management in support of glycemic control may result in more comprehensive T2D management.^1,2,3

In patients with T2D and overweight or obesity, weight loss can be associated with improvement in glycemic control. In the Look AHEAD (Action for Health in Diabetes) study evaluating intensive lifestyle intervention (ILI) in comparison to conventional care, participants in the ILI group were more likely to lose weight and also more likely to achieve ancillary benefits of decreased medication use.^4-7

Findings from the Look AHEAD trial

The Look AHEAD trial examined the long-term effects of lifestyle interventions on cardiovascular (CV) morbidity and mortality in 5145 adults with T2D and overweight or obesity who received ILI or diabetes support and education (DSE). The trial was stopped due to futility analysis, with no demonstrated significant intergroup difference in the primary CV outcome.^2,7,8*

*Primary eligibility criteria: being aged 45-76; having a BMI ≥25 kg/m² (≥27 kg/m² if treated with insulin), systolic and diastolic blood pressure <160/100 mm Hg (with or without antihypertensive drugs), and triglycerides <600 mg/dL (with or without drugs for dyslipidemia); and successful completion of a valid maximal-graded exercise test.^2,7

1-year data demonstrated significant changes in multiple study measures in the ILI group compared with the DSE group⁷

According to the American Diabetes Association, modest and sustained weight loss may reduce the need for additional medications in patients with T2D and obesity.³

In patients with T2D and obesity, modest and sustained weight loss leading to clinically meaningful improvements in glycemic control, lipids, and blood pressure may reduce the need for additional medications to control these risk factors.

*Defined in a 2022 consensus report as normal blood glucose levels for 3 months or more in the absence of pharmacological therapy.¹³

The benefits of early intensive glucose lowering have been well established.¹³ Prioritizing weight management can support early glycemic control.⁵

According to the UK Prospective Diabetes Study (UKPDS),* early intensive glycemic control (A1C <7%) has been associated with reducing the long-term risk of complications in patients with T2D (compared to conventional care at the time of the study).^14,15

Please note that weight loss was not part of the UKPDS trial. On average, participants in the UKPDS trial gained weight, potentially associated with the use of sulfonylureas and insulin.¹⁴

*The UK Prospective Diabetes Study (UKPDS) was designed to evaluate whether intensive blood glucose control reduced the risk of vascular complications. Between 1977 and 1991, 3867 eligible patients (newly diagnosed with type 2 diabetes, 25 to 65 years of age, with a fasting plasma glucose level >6 mmol/L on 2 mornings, 1-3 weeks apart) were randomly assigned to an intensive regimen with treatment or a conventional regimen with diet. The exclusion criteria were: ketonuria more than 3 mmol/L; serum creatinine greater than 175 μmol/L; myocardial infarction in the previous year; current angina or heart failure; more than 1 major vascular event; retinopathy requiring laser treatment; malignant hypertension; uncorrected endocrine disorder; occupation that precluded insulin therapy; severe concurrent illness that would limit life or require extensive systemic treatment; inadequate understanding; and unwillingness to enter the study^14
†Early intensive glycemic control was with sulfonylureas, insulin, or metformin compared with conventional dietary therapy.¹⁴

The DiRECT: Diabetes Remission Clinical Trial*

Glycemic control was assessed in participants with T2D (≤6 years), 20 to 65 years of age, who were provided either a structured weight-management program (intervention group) or diabetes management per current best practices. Additionally, patients in the intervention group had all antihyperglycemic and antihypertensive medications withdrawn at baseline.⁶

*40% of participants in the intervention group required medications; 84% in the control group required medications. This statement reflects calculated values from Lean MEJ, et al.⁶

In year 2 of this analysis, participants with greater maintained weight loss were more likely to have an A1C <6.5%, as demonstrated in a post hoc analysis of the entire study population (pooled intervention and control participants) by weight-loss category. In this analysis, an A1C <6.5% was achieved by⁶:

*DiRECT (Diabetes Remission Clinical Trial) was a 2-year, open-label, cluster-randomized controlled trial designed to assess remission of type 2 diabetes during a primary care-led weight-management program, as well as the durability of the intervention effect. 149 patients were included in the intervention group, 149 in the control group. Eligible participants were aged 20-65 years, had been diagnosed with type 2 diabetes within the previous 6 years, and had a BMI of 27-45 kg/m². Exclusion criteria included current insulin use, A1C of 12% or higher, weight loss of more than 11 lb within the previous 6 months, and a recent recorded estimated glomerular rate of less than 30 mL/min per 1.732 m².⁶

Treating excess weight in T2D is a component of a patient-centered approach that, if started early, can support early glycemic control.^3,13

Patients with T2D and excess weight may benefit from formal medical support.¹

T2D=type 2 diabetes.

References