Welcome to your excess weight in type 2 diabetes (T2D) RESOURCE HUB

Early intensive glycemic control is associated with a decreased risk of T2D-related complications.^1,2 The UKPDS trial* compared newly diagnosed patients with T2D in 2 study groups. Participants were randomly assigned to 1 of 2 treatment regimens: either an intensive treatment regimen to rapidly achieve glycemic control or a more conventional regimen using diet alone.¹ Results demonstrated that early intensive glucose therapy reduced the risk of microvascular complications (25%) over 10 years compared with the conventional group.¹ The follow-up results from the 10-year post-trial monitoring showed that these reductions were sustained for microvascular risk (24%), and emergent risk reductions for myocardial infarction (15%) were also observed.²

*The UK Prospective Diabetes Study (UKPDS) was designed to establish whether intensive blood glucose control reduced the risk of vascular complications. Between 1977 and 1991, 3867 eligible patients (newly diagnosed with 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.¹

Excess weight, particularly excess abdominal fat, is associated with insulin resistance in T2D.^3-5 Excessive fat accumulation is associated with pathological expansion in adipose depots, adipocyte dysfunction, increase in inflammatory signals, and elevation of plasma lipids.^6,7 Additionally, based on animal models, excess circulating lipids may contribute to β-cell dysfunction, which can worsen with T2D.^8,9 Therefore, excess weight is a key component in 2 core pathophysiological defects in T2D—insulin resistance and β-cell failure.^7,8,10

The American Diabetes Association says, “For many people with T2D, glucose monitoring is key to achieving glycemic targets. In addition, diabetes self-management education and support (DSME/S), medical nutrition therapy (MNT), routine physical activity, smoking cessation counseling when needed, and psychosocial care are essential to achieving diabetes treatment goals and maximizing quality of life.” Click here for resources.¹¹

Use the “6A’s” framework for initiating conversations with patients about obesity management¹²:

1. ASK the patient’s permission to address weight
2. ASSESS the patient’s desired weight-loss goal and reasons for wanting to lose weight
3. ADVISE the patient about treatment options that align with the patient’s goals and are most likely to help the patient achieve the desired results
4. AGREE on weight loss, lifestyle, and behavioral goals with the patient
5. ASSIST the patient by creating a plan
6. ARRANGE for patient engagement in the treatment plan and close follow-up